Gall bladder stone treatment – Laparoscopic cholecystectomy
Gall bladder stone treatment involves laparoscopic surgery for removal of the diseased gall bladder along with the contained stones.By new SILS- single incision laparoscopic surgery technique, it can be done by only one small cut in the navel. Usually it requires 3 or 4 small cuts.
Even if at present its asymptomatic, eventually all gall stone swill start giving trouble sooner or later. So when we know that surgery is the only final treatment, why to make it more difficult when all other complications of gall bladder stone disease also start to trouble us. In later stages the difficulty of surgery also increases and hence chances of complications also unnecessarily increases.
In the initial stages of the disease , SILS is possible thereby hardly leaving any visible scars behind. But as the disease becomes complicated, 3 or 4 cuts standard laparoscopy may be required . Sometimes in extremely bad gall bladder conditions, surgeons also might have to resort to open surgery.
Patients of diabetes should definitely not wait for any symptoms to occur before seeking treatment as the symptoms may only be experienced in later stages when gall bladder becomes gangrenous.
A gallstone, is a lump of hard material usually range in size from a grain of sand to 3-4 cms. They are formed inside the gall bladder formed as a result of precipitation of cholesterol and bile salts from the bile.
Types and causes of gallstones
Mixed stones – the most common type. They are comprised of cholesterol and saltsCholesterol stones are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80 percent of gallstones. Scientists believe cholesterol stones form when bile contains too much cholesterol, too much bilirubin, or not enough bile salts, or when the gallbladder does not empty as it should for some other reason.Pigment stones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.Other causes are related to excess excretion of cholesterol by liver through bile. They include the followingGender. Women between 20 and 60 years of age are twice as likely to develop gallstones as me
Obesity. Obesity is a major risk factor for gallstones, especially in women
Oestrogen. Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills
Diabetes. People with diabetes generally have high levels of fatty acids called triglycerides
Rapid weight loss.
As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile, which can cause gallstones Symptoms. Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called “silent stones.” Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.
may vary and often follow fatty meals, and they may occur during the night.
Recurring intolerance of fatty foods
Steady pain in the upper abdomen that increases rapidly and lasts from 30 minutes to several hours
Pain in the back between the shoulder blades
Pain under the right shoulder
Nausea or vomiting
Indigestion & belching
Ultrasound is the most sensitive and specific test for gallstones.Other diagnostic tests may include Computed tomography (CT) scan may show the gallstones or complications
Complications of gall bladder stone disease :
Cholecystitis, mucocele, empyema, obstructive jaundice/ choledocholithisis ,gall stone pancreatitis , gall bladder stone ileus, gall bladder cancer.
Endoscopic retrograde cholangiopancreatography (ERCP). The patient swallows an endoscope–a long, flexible, lighted tube connected to a computer and TV monitor. The doctor guides the endoscope through the stomach and into the small intestine. The doctor then injects a special dye that temporarily stains the ducts in the biliary system. ERCP is used to locate and remove stones in the ducts
Blood tests. Blood tests may be used to look for signs of infection, obstruction, pancreatitis, or jaundiceCourse of illnessBile-duct blockage and infection caused by stones in the biliary tract can be a life-threatening illness. With prompt diagnosis and treatment, the outcome is usually very good.ComplicationsThe obstruction caused by gall stone may lead to Biliary colic, Inflammation of gall bladder (Cholecystitis). Other complications may includeCirrhosis- Cirrhosis is the result of chronic liver disease that causes scarring of the liver (fibrosis – nodular regeneration) and liver dysfunction
Cholangitis- Cholangitis is an infection of the common bile duct, which carries bile (which helps in digestion) from the liver to the gallbladder and then to the intestines
Treatment – Surgery to remove the gallbladder is the only way to treat symptomatic gallstones. The most common operation is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in the abdomen and inserts surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures.If gallstones are in the bile ducts, the physician (usually a gastroenterologist) may use endoscopic retrograde cholangiopancreatography (ERCP) to locate and remove them before or during the gallbladder surgery.
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