1. The physiology of the gallbladder and sphincter of Oddi
are regulated by a complex interplay of hormones and neuronal inputs
designed to coordinate bile release with food consumption. Dysfunctions related
to this activity are linked to the development of gallbladder pathologies
described in this chapter.
2. In Western countries, the most common type of gallstones are
cholesterol stones. The pathogenesis of these stones relates to
supersaturation of bile with cholesterol and subsequent precipitation.
3. The main risk factor for gallbladder disease in Western countries
is cholelithiasis. The main complications include cholecystitis,
choledocholithiasis, cholangitis, and biliary pancreatitis. In addition, cholelithiasis
plays the role as the major risk factor for the development of gallbladder
4. Laparoscopic cholecystectomy has been demonstrated to be a safe
and effective alternative to open cholecystectomy and has become
the treatment of choice for symptomatic gallstones. Knowledge of the
various anatomic anomalies of the cystic duct and artery is helpful
in guiding the dissection of these structures as well as avoiding
injury to the common bile duct during cholecystectomy.
5. Common bile duct injuries, although uncommon, can be devastating
to patients. Proper exposure of Calot’s triangle and careful
identification of the anatomic structures are keys to avoiding these
injuries. Once a bile duct injury is diagnosed, the best outcomes
are seen at large referral centers with experienced biliary surgeons.
6. Carcinoma of the gallbladder and bile duct generally have a poor
prognosis because patients usually present late in the disease process
and have poor response to chemo and radiation therapies. Surgery
offers the best chance for survival and has good long-term survival
in patients with early-stage disease.
The gallbladder is a pear-shaped sac, about 7 to 10 cm long,
with an average capacity of 30 to 50 mL. When obstructed, the gallbladder
can distend markedly and contain up to 300 mL.1 The
gallbladder is located in a fossa on the inferior surface of the
liver. A line from this fossa to the inferior vena cava divides
the liver into right and left liver lobes. The gallbladder is divided
into four anatomic areas: the fundus, the corpus (body), the infundibulum,
and the neck. The fundus is the rounded, blind end that normally
extends 1 to 2 cm beyond the liver’s margin. It contains
most of the smooth muscles of the organ, in contrast to the body,
which is the main storage area and contains most of the elastic
tissue. The body extends from the fundus and tapers into the neck,
a funnel-shaped area that connects with the cystic duct. The neck
usually follows a gentle curve, the convexity of which may be enlarged
to form the infundibulum or Hartmann’s pouch. The neck lies
in the deepest part of the gallbladder fossa and extends into the free
portion of the hepatoduodenal ligament (Fig. 32-1).