Purpose of Gallbladder Surgery

Gallbladder surgery is one of the most common surgical procedures performed in the United States, and it is most frequently performed to treat gallstone disease (cholelithiasis). The type of surgical procedure performed on the gallbladder is most often a cholecystectomy (the removal of the gallbladder). More than 600,000 gallbladder removal procedures are performed each year in the U.S., most of which are for symptomatic gallstone disease. But gallstones are not the only purpose of gallbladder surgery. Many other underlying conditions commonly require gallbladder surgery.

Diagnosis Related to Gallbladder Surgery

According to the American College of Surgeons, the most common condition that requires gallbladder surgery is gallstones that cause biliary colic. Biliary colic is a condition involving acute pain in the abdomen; the pain is caused by spasms or by a blockage of the cystic or bile duct.

What Are Gallstones?

Gallstones are hard stones that can form as a result of solidification of substances in the bile (a liquid produced in the liver and stored in the gallbladder that helps break down and absorb fats). These stones can be tiny, grain-like in size, or they can form into large golf-ball-sized stones.

As the bile travels through the biliary system (a system of organs and ducts that function to excrete and store bile), the stones can become stuck. When a stone gets stuck in the common bile duct (which connects the liver, gallbladder. and pancreas to the small intestine) it can cause extreme pain and lead to severe complications—such as pancreatitis—that often results in the need for gallbladder surgery.

When a person has gallstones, it doesn’t necessarily mean that gallbladder surgery is required. But, if there are repeated attacks (or the attack involves severe pain), gallbladder surgery may need to be performed. When a person has a single episode of gallstones involving severe pain, an emergency gallbladder surgery may be required. Sometimes the physician will wait to see if a person has subsequent episodes after the initial gallstone attack. But, the best way to prevent future attacks is removal of the gallbladder. 

Gallstones cause many different complications in the biliary tract, depending on where they are located. If gallstones are left untreated, they could progress into more severe conditions that would warrant gallbladder surgery; these conditions include:

• A stricture of the common bile duct (a tube-like structure that carries bile from the gallbladder into the small intestine). This stricture, commonly caused by gallstones, causes an abnormal narrowing of the bile duct. If left untreated, inflammation of the bile ducts can occur; this is a condition that often leads to the need for gallbladder surgery.
• Acute biliary pancreatitis. This is a potentially life-threatening complication involving inflammation of the pancreas caused by gallstones blocking the pancreatic duct)
• Inflammation of the gallbladder (cholecystitis). Cholecystitis occurs when a gallstone gets stuck in the neck of the gallbladder, causing obstruction of the flow of bile.
• Inflammation of the bile ducts (cholangitis). Cholangitis is often due to an infection.
• Gallbladder cancer. This is a rare disorder, but the risk is increased in those with a history of gallstones.

A cholecystectomy is not the only effective treatment for gallstones; the stones can be removed, but often the surgeon will opt to remove the gallbladder (by performing a cholecystectomy) to prevent future gallstone attacks. Surprisingly, the body can function normally without a gallbladder. There could be some small changes in the way a person digests food after a cholecystectomy, but usually these changes do not cause any noticeable symptoms.

Other Conditions That May Require Gallbladder Surgery

There are several types of gallbladder disease (in addition to gallstones) that commonly necessitate a person having gallbladder surgery, these include:

• Trauma to the gallbladder or bile ducts (which can occur as a result of liver surgery)
• Retention cysts caused by obstructive gallbladder conditions, such as stones, tumors, or sludge. Sludge is a build-up of cholesterol, calcium, and bilirubin that can collect in the gallbladder.
• Cancer of the gallbladder, liver, or the bile ducts
• Hepatitis (infection of the liver)
• Cirrhosis (scarring of the liver)
• Parasites
• Severe damage to the liver
• Large polyps of the gallbladder
• Biliary dyskinesia (the lack of sufficient emptying of the gallbladder, causing severe pain, nausea and intolerance of fatty foods)
• Birth defects such as choledochal cyst (a rare condition involving enlargements of the bile ducts)

Gallbladder Cancer

Gallbladder cancer is a condition that is likely to necessitate gallbladder surgery. According to the American Cancer Society, there are two types of surgery for cancer of the gallbladder. These include:

1. Potentially curative surgery. This may be done for resectable cancer ( (cancer that has a high probability of being completely removed) and unresectable cancer (cancer that has spread too far, is too advanced, or is in a place that prevents it from being completely removed). It is performed when early test results (such as imaging tests and biopsies) show there is a good chance all of the cancer can be removed.
2. Palliative surgery is performed when the cancer is too widespread to remove it completely; it is aimed at relieving symptoms or prevent future complications. In the case of cancer of the gallbladder, palliative surgery is done to relieve the pain caused by blockage of the bile ducts. Palliative surgery may also enable a person with gallbladder cancer to live longer.

When gallbladder cancer is initially diagnosed, only a small percentage of cases are considered resectable.

Tests and Labs

Before gallbladder surgery is ordered by the surgeon, several tests will be performed, these may include:

• Blood tests such as a white blood cell count (WBC) to ensure you don’t have an infection, a test to ensure your blood is clotting properly called a prothrombin time (PT), a complete blood count (CBC), liver function tests. and more
• Chest X-rays to screen for abnormal heart and lung issues
• X-rays of the gallbladder
• Electrocardiogram (ECG) to test for abnormal heart rhythms
• A urinalysis to screen out kidney or bladder problems
• An abdominal ultrasound (the most common test to diagnose gallstones)
• Hepatobiliary iminodiacetic acid (HIDA) scan. The HIDA scan is a nuclear scan aimed at evaluating how well the gallbladder functions
• Endoscopic retrograde cholangiopancreatography (ERCP). ERCP involves a thin tube that is passed through the throat and into the bowel. A dye is then injected to produce high-quality X-rays.

Diagnostic Criteria

Diagnostic criteria involve a set of predetermined signs, symptoms, and test results pertaining to a specific diagnosis. These criteria are used to guide the care of a person. Often, a person’s insurance provider has a list of these pre-set diagnostic criteria—including symptoms and various positive test results—that must be present before a procedure (such as gallbladder surgery) will be approved.

A few examples of the type of diagnostic criteria that may be required by your insurance company, before gallbladder surgery approval will be granted may include:

• A fever over 100.4 F (38.0 C) when the purpose of gallbladder surgery is cholecystitis (inflammation of the gallbladder) or other infections of the biliary system
• Recurrent postprandial (after meals) pain in the upper abdomen or back
• Common bile duct stones or sludge upon ultrasound when the purpose of gallbladder surgery is cholelithiasis (gallstones)
• A polyp larger than 10 millimeters (.39 inches) when documentation confirms that the polyp is not a gallstone (when the purpose of gallbladder surgery is to treat polyps)

The pre-qualifying list may be quite specific, involving several signs and symptoms for each condition that requires gallbladder surgery. Therefore, if you have insurance, it’s important to ask your primary physician's office staff to check with your insurance provider, to ensure that your symptoms and test results warrant coverage for payment for your surgical procedure.

A Word From Verywell

Keep in mind that although insurance providers may be very specific about the symptoms (and lab/test results) you must have, to be diagnosed with a condition warranting gallbladder surgery, anytime you have very severe abdominal pain, it’s important to seek immediate medical care. When the pain is severe, and other signs lend themselves to a gallbladder condition, an emergency cholecystectomy may be ordered. The parameters required by insurance providers, to cover medical expenses resulting from emergency surgical procedures, change, compared to a non-emergency procedure.

If you were recently diagnosed with gallbladder cancer, keep in mind that the American Cancer Society recommends getting a second opinion before opting for curative surgery for gallbladder cancer. This is because many healthcare providers disagree on how advanced gallbladder cancer can be when it’s still considered surgically treatable. Most gallbladder cancer surgical procedures are complex; they are usually performed at major cancer centers.