Surgical removal of the gall bladder is called cholecystectomy. Most of us have heard of gall bladder surgery in people. It is not as common a surgery in animals.
Heather, an 11 year old Silky Terrier, came to us with some significant symptoms. They included anorexia for several days and lethargy. Her initial blood panel showed high elevations in Alk Phos., AST, and bilirubin. We could see hepatomegaly on her radiograph. Initial treatment consisted of antibiotics, fluids, vitamin supplements, and I/D food. Heather rapidly got better on the treatment.
She had a recurrence of the problem 3 weeks later. At that time an ultrasound was performed and it was determined that she had a “porcelain bladder”. Her gall bladder was thickened and mineralized, and it contained gall stones. She responded well to treatment with antibiotics and actigoll. When her enzyme test were almost back to the normal range we removed her gall bladder.
This is a specialized surgery that is tedious and requires an experienced surgeon. In Heather’s case we called in Dr. Linda Larsen, a specialist in surgery.
Monitoring of anesthesia is critical in an older pet with liver disease. Monitoring Heather’s blood pressure is an important aspect of anesthesia.
We keep a close tab on important physiologic parameters for all of our surgeries. Monitors like this give us an early warning of an impending problem.
Once our surgeon has scrubbed up and is in sterile gown, gloves, and mask, the surgery begins
Once the initial incision was made in Heather’s abdomen we worked on exposing the liver. In this picture we are removing normal fat, called falciform fat. Removing it greatly aids in visualizing the gall bladder. In most surgeries of the abdomen we do not need to do this. The brownish-red structure below the fat is the liver.
After the fat is removed we start to get better visualization of the gall bladder (arrow).
We isolated the gall bladder and traced it down to the common bile duct. The arrow points to the gall bladder under our surgeon’s finger. The vertical bluish structure below the gall bladder is the common bile duct.
After we viewed the gall bladder and common bile duct we placed stay sutures in the gall bladder (GB). This helps in the removal of the gall bladder.
Several stay sutures are placed. They aid in the dissection by keeping gentle tension on the gall bladder as we dissect it off the liver. They also help minimize the trauma of the dissection.
When the stay sutures are in place the actual dissection begins. The gall bladder’s attachment to the liver is highly vascular. You can see this as Dr. Larsen gently dissects with a sterile cotton-tipped applicator.
As the surgery proceeds you can see the gall bladder (GB) being slowly pulled away from the liver.
Eventually we dissect the gall bladder down to the common bile duct. Several sutures are placed around the junction of the gall bladder and common bile duct.
After the sutures are secure we cut the gall bladder at its base and remove it
All that remains are the sutures at the common bile duct
Our next procedure is a liver biopsy. The first aspect of the biopsy is the placement of a suture around the tip of one of the liver lobes. The liver is a highly vascular organ, so control of bleeding (called hemostasis) is critical.
The suture is pulled snug and a piece of the liver is cut away with the scissors
There is no bleeding at the biopsy site with this technique
We never pass up the opportunity to check all the abdominal organs during abdominal surgery. This is the spleen. Even though it is large, it is normal.
The inside of the gall bladder after removal. The chronic thickening is apparent.
These are the gall stones that were found in the gall bladder
The pathology report on the gall bladder
This is the analysis of the stones found in the gall bladder