Gallbladder stones or gallstones are crystalline masses formed abnormally in the gall bladder or bile ducts from bile pigments, cholesterol, and calcium salts. Gallstones can cause severe pain and blockage of the bile duct. When the wall of the gallbladder is diseased then it produces the stone and polyps etc.
The two main types of gallstones are:
Cholesterolstones: Usually yellow-green in color, approximately 80% of gallstones are cholesterol stones.
Pigment stones: These stones are smaller and darker and are made up of bilirubin.
Who is at risk for gallstones?
Many patients with gallstones have no symptoms, these patients are said to be asymptomatic and these stones are called ‘Silent stones’.
Gall bladder polyp include all mucosal projections into the gall bladder lumen and include cholesterol polyps, adenomyomas, inflammatory polyps, adenomas and other miscellaneous polyps. Most of this ultimately leads to formation of stones or in malignancy inlarge polyps.
Bile duct and pancreatic duct open in intestine through common opening. Gallstones, produced in the gallbladder, can block the bile duct, stopping pancreatic enzymes from traveling to the small intestine and forcing them back into the pancreas. The enzymes then begin to irritate the cells of the pancreas, causing the inflammation associated with pancreatitis. This is very serious clinical condition with severe sufferings. In many severe cases it may be fatal as well.
Association of gall bladder stones with gall bladder cancer is well established. It is a well-documented medical fact that more than 85% gallbladder cancers have shown to have gall bladder stones as well.
The female gender, multiple child births and obesity are also some of the factors that are associated with higher risk of developing gall bladder cancer. The evidences point towards the environmental and genetic factors playing an important role in development for gallbladder cancer. The basis for development of cancer in the setting of gallbladder stones likely occurs through chronic irritation and local production of carcinogens. The larger the gallstones (more than 2-3 cm in diameter), the greater the association with gallbladder cancer. Stone more than 3 cm is considered as pre-malignant condition.
Surgery: Surgery to remove the gallbladder (cholecystectomy) is the only way to cure gallstones. This can be done by conventional (open) method or a well-established endoscopic (laparoscopic) method which is now the 'Gold Standard'.
The surgery is called Laparoscopic Cholecystectomy (Lap. Chole). For this operation, the surgeon makes few tiny punctures in the abdomen and inserts surgical instruments and a miniature telescope with amounted 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 vessels. The gallbladder is then removed through one of the small incisions. Recovery usually occurs within few hours in most of the cases in the hospital, followed by few days of rest at home. As there is no damage to the muscle (muscles are not cut) during laparoscopic surgery, patients have less pain and negligible wound complications.
If the surgeon finds any difficulty in the laparoscopic procedure, the operating team may decide to switch over to open surgery. It is called open surgery because the surgeon has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder. Open surgery has faded into the background with the laparoscopic technique providing significant advantages and ease for the patient.
Slippage of the stone(s) in CBD may cause pain or jaundice or both. This situation requires an endoscopy (ERCP) for removing the stone(s). This should preferably be done before surgery. However it may also be done after the operation.
Sometimes a stone in the CBD may not show on ultrasound; however patient may have symptoms which are indicative of the same. In this event, the patient requires magnetic resonance cholangiopancreatography (MRCP - an MRI scan) which shows the presence of stones in the common bile duct.
The surgeon may use endoscopy through mouth for removing CBD stones before gallbladder surgery. Once the endoscope is in the small intestine, the surgeon locates the opening of the bile duct. An instrument on the endoscope is used to cut the duct, and the stone is captured in a tiny basket and removed with the endoscope. This two-step procedure is called ERCP andEPT.
Non-surgical approaches are used only in special situations such as when a patient's condition is not fit for anaesthesia and surgery. This does not cure the patients as it only provides symptomatic relief.
Fortunately, the gallbladder is an organ that people can live without. Losing it doesn’t require any change in diet. Even when the gallbladder is removed, bile production remains unaffected as it is produced in the liver. The bile by liver helps in digestion of food as before.
Its main purpose is to store and concentrate bile produced by the liver. Bile is released from the gallbladder after eating, aiding digestion. Bile travels through common bile ducts (CBD) into the small intestine.
Gallstones are pieces of solid material that form in the gallbladder. These stones develop because cholesterol and pigments in bile sometimes form hard particles.
Cholecystitis is defined as inflammation of the gall bladder. Most commonly this happens when the flow of bile is stopped or interrupted due to stone (90%) or if infection of biliary tract occurs.
The usual symptomsof cholecystitis are:
The symptomatic stones and diseased gallbladder should be removed by a surgical procedure called Cholecystectomy.
No, the gall bladder is removed with the stones, otherwise the stones may form again.
Fortunately, the gallbladder is an organ that people can live without. Losing it won’t even require a change in diet. Once the gallbladder is removed, bile flows out of the liver through the hepatic ducts into the common bile duct and goes directly into the small intestine, instead of being stored in the gallbladder.
Slippage of the stone(s) in CBD may cause pain or jaundice or both. This situation requires an endoscopy (ERCP) for removing the stone(s). This should preferably be done before surgery. However it may also be done after the operation
Generally, hospital stays are between one to two days.
In general, plan to take about one week off from work.
Mostly the procedure is covered under most medical insurance plans. Please confirm in your policy documents
"World Heaviest Boy loses 67kgs of weight after Bariatric Surgery" Mihir, this young 14 year old boy has a will power that will move you! A truly motivational story of Mihir and his family. They have struggled with his weight since he was just 5. And finally after much pre operative hard work from the team and his family, we could operate.
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