Laparoscopic surgery of gallbladder has became a ‘Gold standard’ today because of

1. Short hospital stay
2. Faster recovery
3. Minimal pain
4. Minimal scaring and better cosmesis
5. Less complication.

It is a patient friendly ‘key hole’ surgery and the common indications are.

1. Symptomatic Gall stone disease.Mucocele
2. Acute cholecystitis
3. Empyema
4. Gangrenous cholecystitis
5. Along with bariatric surgery
6. Gall bladder Polyp of more than 1cm size

As yet Lap Chole has no role to play in G.B. Malignancy. We have by now performed more than 10000 Lap Chole in all indication mentioned above with less than 0.1% mortality and 0.05% CBD injury and less than 1% infection rate. Coexisting CBD stone if detected preoperatively can be easily managed by therapeutic G.I. endoscopy. Intraop flouro-cholangiogram can be performed and CBD stone can be cleared in same sitting with good results In heredity Spherocytosis Lap Chole can be easily combined with splenectomy. We can performed such surgery in 6 cases so far.

FAQ :-

What are Gallstones?

The liquid, called bile, is used to help the body digest fats. Bile is made in the liver, then stored in the gallbladder until the body needs to digest fat. At that time, the gallbladder contracts and pushes the bile into a tube called a common duct that carries it to the small intestine, where it helps with digestion.

Bile contains water, cholesterol, fats, bile salts, and bilirubin. Bile salts break up fat, and bilirubin gives bile and stools a brownish color. if the liquid bile contains too much cholesterol, bile salts, or bilirubin, it can harden into stones.

The two types of gallstones are cholesterol stones and pigment stones. Gallstones can be as small as a grain of sand or as large a a golf ball. The gallbladder can develop just one large stone, hundreds of tiny stones, or almost any combination.

Gallstones can block the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine. That includes the hepatic ducts, which carry bile out of the liver, the cystic duct, which takes bile to and from the gallbladder, and the common bile duct, which takes bile from the cystic and hepatic ducts to the small intestine. Bile trapped in these ducts can cause inflammation in the gallbladder, the ducts, or rarely, the liver. Other ducts open into the common bile duct, including the pancreatic duct, which carries digestive enzymes out of the pancreas. If a gallstone blocks the opening to the duct, digestive enzymes can become trapped in the pancreas and cause an extremely painful inflammation called pancreatitis.

If any of these ducts remain blocked for a significant period of time, severe possible fatal damage can occur, affecting the gallbladder, liver, or pancreas. Warning signs of a serious problem are fever, jaundice, and persistent pain.

What is a Gall bladder?

Gall bladder is a pear shaped organ present close to the liver. Its function is to store and concentrate bile juice which is secreted by liver for digestion of fats.

What causes Gallstones?

Cholesterol Stones

Scientists believe cholesterol stones from 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

The cause of pigment stones is uncertain. They tend to develop in people who have cirrhosis, biliary tract infections, and hereditary blood disorders such as sickle cell anemia.

Other factors

it is believe that the mere presence of gallstones may cause more gallstones to develop. However, other factor that contribute to gallstones have been identified, especially for cholesterol stones.

Who is at risk for Gallstones?

What are the Symptoms?

Symptoms of gallstones are often called a gallstone "attack" (colic) because they occur suddenly. A typical attack can cause

Gallstone attack often follow fatty meals, and they may occur during the night. Other gallstone symptoms include

People who also have the following symptoms should see a doctor right away:

Many people with gallstones have no symptoms. These patients are said to be asymptomatic, and these stones are called "silent stones". They do not interfere in gallbladder, liver, or pancreas function.

How are Gallstones diagnosed?

Ultrasound examination:

Many gallstones, especially silent stones, are discovered by accident during tests for other problems. But when gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam. Ultrasound uses sound waves to create images of organs. If stones are present, the sound waves will bounce off them, showing their location.

Other tests used in diagnosis include

Gallstone symptoms are similar to those of heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis. So accurate diagnosis is important.

What are the complications?

What is the treatment?

Surgery

Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. The Standard surgery 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 uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures. Then the cystic duct is cut and the gallbladder removed through one of the small incisions.

Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision across the abdomen. Recovery usually involves only one night in the hospital, followed by several days of restricted activity at home.

If the surgeon discover any obstacles to the laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery. It is called "open" surgery because has to make a 5 to 8 inch incision in the abdomen to remove the gallbladder. This is a major surgery and may require about a 2 to 7 day stay in the hospital and several more weeks at home to recover. Open surgery is now required in less than 2 percent gallbladder operations, in specialized canter.

The most common complication in gallbladder surgery is injury to the ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection. Mild injuries can sometimes be treated nonsurgically. major injury, however, is more serious and requires additional surgery.

If gallstones are in the bile ducts, the surgeon may use ERCP in removing them before or during the gallbladder surgery. Once the endoscope is in the small intestine, the surgeon locates the affected bile duct. An instrument on the endoscope is used to cut the duct, and the stone is captured in tiny basket and removed with the endoscope. This two-step procedure is called ERCP with endoscopic sphincterotomy.

Nonsurgical treatment

Nonsurgical approaches are used only in special situations such as when a patient's condition prevents using an anesthetic and only for cholesterol stones. Stones recur after nonsurgical treatment about half the time.

Don't people need their Gallbladders?


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. However, because the bile isn't stored in the gallbladder, it is flows into the small intertine more frequently, causing diarrhea in some people. Also some studies suggested that removing the gallbladder may cause higher blood cholesterol levels, so occasional cholesterol tests may be necessary.

What to do if the stones are found on routine investigation without any prior symptoms?

Earlier thought was to leave the asymptomatic stones alone till the symptoms occur. Now with the advent of laparoscopic cholecystectomy which enclaves minimal suffering its better to get the gall bladder out than wait for the symptoms and complications to occur.

What are the restrictions after the surgery?

There are no restrictions of dict or physical activity. Patient is put on a normal diet and allowed normal physical activity from the next day of surgery.