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Gallbladder Surgery
The gallbladder is a small, pear-shaped organ that lies just beneath the liver in the upper right part of your abdomen. The gallbladder collects and stores bile, a digestive juice produced by the liver, and excretes it (through the common bile duct) into the intestines. The purpose of bile is to help digest large fatty meals. Gallstones (Cholelithiasis)/ Sometimes, stones (usually made of cholesterol, bile salts and lecithin) form in the gallbladder and block its outlet, causing pain (Biliary colic) or inflammation and infection (Cholecystitis). Sometimes the stones move out of the gallbladder but get stuck in the common bile duct, and can cause inflammation of the pancreas (Pancreatitis), fever, or jaundice (yellow color in the skin and eyes). Pain usually begins after a meal and may become severe and constant. There may be more symptoms after eating fatty foods. Other symptoms may include bloating, belching, vomiting, and indigestion. Some patients have no symptoms.
Diagnosis of Gallstones
Diagnosis is most often made by ultrasound, the same technique used to visualize fetuses in pregnant woman. With this technique, a detailed image of the gallbladder contents, including stones, can be produced.
Risk Factors of Gallstones
Men, women, and children can all get gallstones. They appear to be more common in obese women over the age of 40. Native Americans and Hispanics may also have higher rates. The overall incidence is 1 out of 1000 people. Women who exercise regularly may reduce their chance of getting gallstones.
Causes of Gallstones
The causes are still mostly unknown, although it is presumed that changes in the composition of the bile substance and failure of the gallbladder to empty properly are contributing causes.
Treatment for Gallstones
Medication and adjustments in the diet (low fat) can help alleviate some of the symptoms. However, if stones block the gallbladder outlet or are lodged in the bile duct, surgery is indicated. Patients who have symptoms, even minor ones, have a diseased gallbladder should strongly consider surgery. For patients with no symptoms, there is a significant risk that the first attack will be severe and require hospitalization, for this reason, such patients should also consider surgery. Furthermore, patients who are at increased risk for infection (such as diabetics or people undergoing chemotherapy) should consider removal of a diseased gallbladder. For these patients, a severe and acute attack may be very dangerous.
Gallbladder Surgery
There are two ways to perform gallbladder surgery: Open Cholecystectomy or Laparoscopic Cholecystectomy.
Open Cholecystectomy
An abdominal incision is made to expose the gallbladder, located under the right portion of the liver. The gallbladder with its stones is removed. Once the gallbladder has stones, it is diseased and cannot be left behind. Removal of gallstones alone is not standard accepted practice. Usually an X-ray test called the Intra-operative Cholangiogram is done during the surgery to see if gallstones are also in the common bile duct. If this test shows stones, then the common bile duct is explored and these stones are removed. Local anesthesia is given at the incision sites to help reduce pain, the incisions are all closed, and a dressing is applied.
Laparoscopic Cholecystectomy
A telescopic instrument called a laparoscope is inserted into a small incision at the belly button (umbilicus). The laparoscope is connected to a tiny video camera which projects a magnified view of the operative site onto video monitors. These video monitors help your surgeon perform the surgery. Carbon dioxide is passed through the laparoscope to fill the abdominal cavity, providing your surgeon with a better view. Small abdominal incisions (one-fourth to one-half inch) are usually made near the primary one at the umbilicus to pass in special surgical instruments with which the operation is performed and the gallbladder removed. The common bile duct is usually examined with use of an Intra-Operative Cholangiogram to make sure that no stones have migrated into the duct.
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