Gallstone disease surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Surgery is not the first-line treatment option for patients with asymptomatic gallstones. Surgery is usually reserved for patients with either symptomatic gallstones and willing to undergo surgery, had complications due to gall stones or are at risk of gallbladder cancer, and having symptomatic recurrent attacks.
Indications
Surgery is usually reserved for patients with either:
- Complications related to gallstones
- Recurrent biliary colic
- Risk of gallbladder cancer
Surgery
Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Only symptomatic patients must be indicated for surgery. The lack of a gall bladder does not seem to have any negative consequences in many people. However, there is a significant proportion of the population, between 5-40%, who develop a condition called postcholecystectomy syndrome.[1] Symptoms include gastrointestinal distress and persistent pain in the upper right abdomen.
There are two surgery options:
- Open procedure
- Laparoscopic
- Open cholecystectomy procedure: This involves a large incision into the abdomen (laparotomy) below the right lower ribs. The patient is hospitalized for one week post surgery, with a return to normal diet and activities one week after release.
- Laparoscopic cholecystectomy: About 4 small puncture holes are made for the insertion of a camera and instruments. Laparscopic surgery has the advantage of a shorter hospital stay, typically one day, with shorter recovery times and less post operative pain. Studies have shown that this procedure is as effective as the more invasive open cholecystectomy, provided the stones are accurately located by cholangiogram prior to the procedure so that they can all be removed. The procedure also has the benefit of reducing operative complications such as bowel perforation and vascular injury.[2][3][4][5][6]
References
- ↑ "Postcholecystectomy syndrome". WebMD. Retrieved 2007-08-25.
- ↑ Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW (1992). "Laparoscopic cholecystectomy. The new 'gold standard'?". Arch Surg. 127 (8): 917–21, discussion 921–3. PMID 1386505.
- ↑ Schirmer BD, Edge SB, Dix J, Hyser MJ, Hanks JB, Jones RS (1991). "Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis". Ann. Surg. 213 (6): 665–76, discussion 677. PMC 1358601. PMID 1828141.
- ↑ Wiesen SM, Unger SW, Barkin JS, Edelman DS, Scott JS, Unger HM (1993). "Laparoscopic cholecystectomy: the procedure of choice for acute cholecystitis". Am. J. Gastroenterol. 88 (3): 334–7. PMID 8438837.
- ↑ Wilson RG, Macintyre IM, Nixon SJ, Saunders JH, Varma JS, King PM (1992). "Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis". BMJ. 305 (6850): 394–6. PMC 1883122. PMID 1392919.
- ↑ Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, Mayumi T, Yoshida M, Strasberg S, Pitt HA, de Santibanes E, Belghiti J, Büchler MW, Gouma DJ, Fan ST, Hilvano SC, Lau JW, Kim SW, Belli G, Windsor JA, Liau KH, Sachakul V (2007). "Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 91–7. doi:10.1007/s00534-006-1161-x. PMC 2784499. PMID 17252302.