Cholecystectomy, the surgical removal of the gallbladder, is the most common elective surgery procedure carried out on Belizeans. Hard statistics are not easy to come by as some Belizeans opt to do surgery in Merida, Chetumal or Guatemala – mostly because it’s perceived as cheaper (when you factor in the cost of travel it’s not really cheaper). An estimate on gallbladder surgeries done in Belize is about 600 a year. Of these about 200 are done in private hospitals and the rest in public hospitals. In the U.S.A. approximately 500,000 persons undergo surgery every year simply because of gallstones. So what are gallstones and gallbladder disease?
The gallbladder is a sac located under the liver. It stores and concentrates the bile produced in the liver, which aids in the digestion of fats. Bile is released from the gallbladder in response to food, especially fats, in the upper small intestine (duodenum).
Conditions which slow or obstruct the flow of bile out of the gallbladder result in gallbladder disease. The two main types of gallbladder disease include: Cholecystitis (inflammation of the gallbladder) and Cholelithiasis (gall stones). Gallstones form when liquid stored in the gallbladder hardens into pieces of stone-like material. Gallstones can be as small as a grain of sand or as large as a ping-pong ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination. Symptoms include abdominal fullness, gas, abdominal pain, severe pain located on the right side or in the upper middle of the abdomen. Pain often but not always follows meals. Women who have had gallbladder attacks compare the pain with that of childbirth. Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or, rarely, the liver. Most physicians will advise patients suffering from gallstones to have the gallbladder surgically removed.
My Gallbladder Removal: First Person Account
I had suffered indigestion and gas, the doctors call it dyspepsia), for a number of years. I had to be on daily medication (omeprazol) for acid reflux in my stomach. The third week of April 2004 I ate too much at lunch. That night I hardly slept because of severe pain. Monday morning found me racing down to Belize City looking for an ultrasound.
Radiologist Dr. Virginia Smith attended to me. “We have stones today, lots of them,” announced Virginia within seconds of applying the transducer to my right side. The stones were small but numerous – on the screen they looked like a string of pearls. My gallbladder also had a thickened wall. I informally asked what she would do if she had my condition and she told she would take it out. “Sooner or later it will have to come out”, were her words.
Major surgery is feared by any sane person. The thought of being put to sleep and be cut open with the possibility of never making it back gives anyone pause. But as my Dad used to say, “No hay mal que un bien no traiga”, so for me it was a golden opportunity to take stock and get my affairs in order. Being an “A” type personality, I decided to go ahead and have it taken out like yesterday. I interviewed a couple of surgeons for the assignment after getting advice from a few of my doctor friends. When considering surgery it is good to have doctor friends who will give you unbiased and honest appraisals of their colleagues’ credentials and track record. You cannot be shy about scrutinizing the background and reputation of the individuals that will be manipulating very sharp cutting instruments inside your abdomen.
Gallbladder surgery is relatively safe when done by competent physicians, however it is not the easiest procedure to master. If damage is done, serious complications can result. I had considered Universal Health Services but the surgeon I know there, Victor Lizarraga was out of the country at the time.
So I interviewed Dr. George Gough. George specializes in laparoscopic surgery and does surgery at Belize Medical Associates – the top private hospital in the country. He has also served as gross anatomy professor at several medical schools in Belize and abroad. Doctor Gough’s frankness and down-to-earth demeanor immediately impressed me. He answered all my questions and gave me referrals to check out. After mulling about it for about a week, I decided to let him do the surgery, assisted by another surgeon Dr. Gregorio Pot as the backup. I went ahead and selected Doctor Nerida De Paz as my anesthesiologist.
When my Dad had his gallbladder removed 30 years ago, it was done via a long incision – about 8 inches on the side. This is called open Cholecystectomy. Today laparoscopic surgery is the preferred method as the recovery time is shorter and you spend less time in the hospital. During a laparoscopic surgical procedure, four small incisions of up to half an inch are made in the abdominal wall, and plastic tubes called ports are placed through these incisions.
Carbon Dioxide gas is infused into the abdomen inflating the stomach like a balloon. This makes space for the instruments. A tiny camera along with cutting and manipulation holding instruments are then introduced through the ports. The camera transmits an image of the organs inside the abdomen onto a television monitor. The surgeon is not able to see directly into the patient without the traditional large incision. The video camera becomes a surgeon’s eyes in laparoscopic surgery, as the surgeon uses the image from the video camera to perform the procedure. The surgeons will ask your permission to convert to an open operation if problems are encountered.
I drove down to Belize City myself with my 18 and 11-year-old sons. I had downloaded and burnt a CD of relaxing music, mainly Bach and Beethoven and played it along the way, much to the consternation of the boys. For once they uttered not one word of complaint. Picture Above: My surgery in progress. At left my surgeon Dr. George Gough.
I checked in at Belize Medical Associates at 7:30 a.m. In no time I was placed in one of those flimsy hospital gowns. Then two nurses shaved my abdomen clean. After the anesthesiologist started her preparations, I found myself saying goodbye to my loved ones and was whisked upstairs.
I think hospitals do this part as quickly as possible to cut down on the possibility of nervous patients deciding to chicken out and jump out of the gurney at the last minute. Anyway, I personally was glad for this, as I wanted to get it over as quickly as possible. I found myself chatting up a storm, this time with the anesthesiologist Dr. Depaz. I am a techno geek and I was peppering her with a multitude of questions on the vital signs monitors she would be using, including my specific request to have her do capnography monitoring during the operation.
This monitoring contributes to a significant reduction of risk during the anesthesia. Capnography monitors the carbon dioxide content in a patient’s exhaled breath. This ensures that oxygen is being properly delivered and utilized by the body. Capnography has been recommended as compulsory for all anesthesia procedures by the American Society of Anesthesiologists since 1986. Dr. Depaz fitted me with face gas mask and then told me “Take a deep breath”. I recall smelling a slightly pungent odor and it was lights out for me.
My surgery took two and a half hours. Dr. Gough told me later that recurrent inflammation and gall bladder attacks had led to several adhesions that had to be carefully removed. The gall bladder had about a hundred small stones. I slept through most of the early afternoon after the surgery. I had mild pain, and colic like discomfort when I fully came to my senses in the late afternoon.
The nurses were very professional and kind and checked me every hour taking blood pressure, and temperature. I was discharged the following afternoon and driven home. My recovery was rapid. The first few days there was abdominal discomfort and I could not sleep on my stomach or side. I got tired very easily. The first day just walking around the bedroom was laborious. My girlfriend was very kind to me during this time and slept over to assist me and wake me up for my antibiotics, painkiller and anti-spasmodic. The third day after my surgery I went downstairs. On day five I ventured into the garden to say hello and play with our Chihuahua.
On day seven, anxious to fly the coop I went to the National Agriculture Show and this was an experience to forget. It was rainy and muggy and muddy. There was an infernal din from what appeared to be a disco box on every corner blasting out rap music through a haze of smoke from dozens of barbecue fires. This, along with the suffocating press of thousands of bodies tortuously navigating the narrow and slippery paths and bumping into each other completely sapped what little energy I had regained. I did not accept any blood for this surgery.
I staggered out to my vehicle and headed home totally knackered, as the British would say. I began to feel more fully recovered fourteen days after the surgery. A month after the surgery I was at 100 per cent. I’ve lost about 9 pounds since my doctor ordered me to lay off fatty food. The pain from the gall bladder is gone, my scars have healed quite nicely and I feel great. Dr. Hugh Sanchez did the pathology report and confirmed that apart from the stones, I had a “raspberry” gallbladder, timely to throw it out. 2015 update – regained the 9 pounds. – By M.A. Romero