Gall Bladder
Gall stone and Laparoscopic Cholecystectomy?

What is gall bladder?

The gall bladder is pear shape organ that sits beneath the liver in right upper abdomen. Its functions are to store bile. It is attached to the bile ducts that come from the liver. These ducts carried bile from the liver to the gall bladder and intestine where bile helps digest foods.

The gall bladder is not necessary to maintained good health.

What are gall stones?

Gall stones usually found in the gall bladder because of excessive cholesterol in bile. They are mainly composed of cholesterol (fat), Bilirubin (bile pigment and calcium with small amount of protein and other material. Non cholesterol stones can be black or brown pigment stones. Only 15% of gall stones can be seen on abdominal X-ray. They are usually diagnosed on sonography.

What are causes of gall stones?

The various risk factors have been identified for gall stone formation:

Age more than 40 years.

Female Sex

Pregnancy

High fat Diet

Obesity

Type to DM

Rapid weight loss

Haemolysis

Bile infection

OCPs

What are symptoms experienced due to gall stones?

Right upper abdominal pain with nausea vomiting.
Fullness of stomach.
Acute Cholecystities.
Chronic Cholecystities.
Infection of bile (Pain, fever jaundice)
Billiary Pancreatitis.

How is gall stone diagnosed?

Blood investigations are usually normal in uncomplicated gall stones. Blood test usually used to diagnosed complicated gall stones. X-ray abdomen can show only 15% of gall stones. USG method most often used to detect Cholelithiasis. It is 96% sensitive. CT scan can be performed only if there suspicion of gall bladder cancer. MRCP has been used in patients, who are unlikely to receive therapeutic intervention. ERCP is used to diagnose and treat stones in bile duct it is used in present of jaundice, fever and USG findings s/o blockage to the flow of bile.

What are Treatment options available for gall stones?

In the past open abdominal surgery was a standard method. The procedure required 6-8 days stay in hospital and 6-7 inch incision and scar on the abdomen. Using advanced laparoscopic technology it is now possible to remove gall bladder through a tiny incision at the naval.

Depending upon the size, number and chemical make up of gall stones, there is another way to treat the condition. If the stones are small, they may be dissolved with long course of drug therapy but problem may not be permanently relieved.

What is Laparoscopic Cholecystectomy?

The patient receives general anaethesia. Then a small incision is made at the naval and thin tube carrying the video camera is inserted. The surgeon inflates the abdomen with CO2, a harmless gas for easier viewing and to provide room for surgery to be performed. Next two needle like instrument are inserted. These serve as tiny hands in the abdomen. They can pick up gall bladder move intestine around and assist the surgeon.

Finally, several different instrument are inserted to clipped GB artery and bile duct and to safely dissect and remove gall bladder and stones.

How Do I prepare for a Laparoscopic Cholecystectomy?

First of all give a complete list of all medicines your taking as well as any allergies you have to drugs and other substances. Let your doctor know if you have heart, lung or other medical conditions that may need specific attention before during or after surgery. One very important step in preparing for surgery is that you should not eat or drink within 6-8 hrs. of you surgery.

The procedure will done on IPD basis. You can be admitted on day of surgery in the morning or one day in advance before surgery. Get a family member to accompanying you for the surgery. You will be seen by an anaesthetic.

What can you expect during the surgery?

During the surgery everything will be done to ensure your comfort. The procedure will be performed under general anaesthesia. It will make you relax and sleepy thus preventing you from remembering much of the experience. Your blood pressure, pulse, oxygen level in the blood will be carefully monitored. Details of laparoscopic Cholecystectomy have already been explained to you. Operation is typically over in about 45 minutes to an hour, depending upon the operative findings. Post operation bandages will be put at the site of surgery which being vary small.

What can your expect after Lap. Cholecystectomy?

Once the operation will over, you will be shifted in the recovery room. In the recovery you will remain drowsy and sedative. Your blood pressure, pulse and oxygen saturation will be monitored. In the recovery room sister will keep strict watch on you. Once you are totally alert, and again reviewed by anaesthetics you will be shifted your respective room. Post-operatively surgeon will visit you in the room and will give necessary instructions for your oral intake and other activities.

What are postoperative orders to be followed?

Post Cholecystectomy you will kept fasting for a minimum period of 6 hours. The period of fasting may be increased depending upon how severely inflamed the gall bladder was. The operating surgeon would see you within 6 hours and advised regarding oral intake. During the period of fasting you will receive IV antibiotics, pain killers and IV fluids. Once oral intake is resumed, depending upon your bowel movements as judged by your surgeon, you will be full normal diet and ready for discharged. Usually discharged within 36-48 hrs depending on the infection of the GB.

 

What are the possible complications?

Even though infrequent, it still carries same risk as open surgery.
Nausea and vomiting
Injury to bile duct a vessel and intestine.
If gall bladder can not be safely removed then standard open surgery needs to be performed, this is however rare at our centre. Our complication rate in last 100 gallbladder surgery is less than 1%.

Can I Have shockwave treatment?

Unlike kidney stones gallbladder stones cannot be treated with shock treatment .In fact such technique; medicines to shorten stones or break them into fragments are dangerous as stones may enter CBD causing life threatening pancreatitis.

Can I have normal food (Alcohol) after Laparoscopic Cholecystectomy?

Yes, 10 days after surgery you may have your normal diet including nonveg fatty food and alcohol.

Is Gall bladder removal mandatory?

Yes, problem lies in wall of Gall bladder hence gall bladder along removed in open or laparoscopic surgery. This will not change your diet, life style, prognosis in future.

 

Do Gall stones need treatment?

If left untreated may be dangerous sometimes.

Infection may develop and gall bladder may become big of pus and emergency surgery needs to be performed.
Some of the small stones can mirgrate into the CBD resulting in obstructive jaundice. Obstructive pancreatitis, yet another major life threatening complication may occur.
 
Where are lap surgery done?

These need sophisticated and expensive instrument and specialized training. So you need a center specializing in these surgeries with well trained surgeons.
 
 
 
 
Director's Corner
DR. SUSHIL LOHIYA
M.B.B.S., M.S.
General Surgery
(Sion, Mumbai)
Fellow in Bariatric & Metabolic Surgery
 
 
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