The gallbladder is an important organ, but it is not essential for life. Therefore, the standard treatment for symptomatic patients suffering from gallstones or acute/chronic cholecystitis (inflammation of the gallbladder) is to surgically remove the gallbladder and gallstones.
For over 100 years, the technique of cholecystectomy evolved little and required a generous abdominal incision, but with the advent of laparoscopy, laparoscopic cholecystectomy has become the "gold standard" in the treatment of gallbladder disease and over 90% are performed using this minimally invasive approach with very low risks and rapid recovery.
Even today, the technique continues to evolve and improve, looking for better recovery times with less pain and better aesthetic results, an example of this continuous evolution is the single port access surgery or mini laparoscopic surgery where instruments of 2 millimeters in diameter are used.
IMPORTANT INFORMATION
GALLBLADDER DISEASES
DIAGNOSIS AND TREATMENT
LAPAROSCOPIC VS. OPEN SURGERY
SURGICAL TECHNIQUE
GALLBLADDER DISEASES
- GALLSTONES (CHOLELITHIASIS/CHOLECYSTOLITHIASIS)
Gallstones are an extremely common condition, occurring in approximately 10 to 36% of the adult population and, as such, represent a major public health problem. Factors contributing to the development of this disease are:
- Female gender
- Obesity (BMI * over 30)
- Pregnancy
- Fatty foods
- Crohn's disease
- Gastric surgery
- Accelerated weight loss
- First-degree relatives with gallstones
Symptoms can be summarized as biliary colic, which refers to the presence of moderate intermittent right upper quadrant and epigastric pain (right upper and central abdominal areas) that may radiate down the right scapula or back, usually beginning abruptly and gradually diminishing after a few minutes to hours.
Complications related to gallstones include acute cholecystitis, choledocholithiasis with or without cholangitis, gallstone pancreatitis, gallstone ileus and gallbladder carcinoma.
- ACUTE / CHRONIC CHOLECYSTITIS
Ongoing inflammation with recurrent episodes of biliary colic or pain is known as chronic cholecystitis; approximately 66% of gallstone patients have these repeated attacks leading to scarring and disruption of normal gallbladder function.
- Symptoms:
- Abdominal pain * Abdominal pain * Abdominal pain * Abdominal pain * Abdominal pain * Abdominal pain * Abdominal pain
- Nausea or vomiting
- Abdominal distention
- Belching
- Fever (not always present)
* The attack of abdominal pain, in this case, usually lasts more than 1 hour, but disappears within 24 hours; If the pain persists for more than 1 day, the underlying cause is likely to be acute cholecystitis.
DIAGNOSIS AND TREATMENT
DIAGNOSIS
It is based on clinical presentation and evidence of gallstones on imaging. An abdominal ultrasound is the standard diagnostic test for gallstones and acute or chronic cholecystitis.
TREATMENT / INDICATIONS
Laparoscopic cholecystectomy, there is no other medical treatment that definitively and permanently resolves gallbladder diseases. It offers excellent long term results with the disappearance of symptoms.
- Indications for laparoscopic cholecystectomy:
- Symptomatic patients with gallstones or gallbladder disease (e.g., acute or chronic cholecystitis)
- Diabetics should be treated immediately because of the increased risk of complications.
- Pregnant women with symptomatic gallstones in whom expectant management fails can safely undergo surgery during the second trimester.
- Biliary dyskinesia or gallbladder dyskinesia
- calcification of the gallbladder wall ("porcelain gallbladder")
- Gallstone larger than 2 cm, even if asymptomatic
- Contraindications:
- Patient unable to tolerate general anesthesia.
- Pregnancy, first or third trimester.
- High bleeding risk
LAPAROSCOPIC VS. OPEN SURGERY
ADVANTAGES OF LAPAROSCOPIC SURGERY
- Very small incisions (3 to 4) and in selected cases, even ONE incision (single port access surgery).
- Rapid recovery time (one night hospitalization)
- Minimal postoperative pain.
- Lower morbidity rate
- Shorter hospital stay
- Return to normal activity and return to work in a shorter period of time (full recovery in 5 to 7 days).
- Decreased risk of wound infection and hernia formation.
- Minimal scarring
COMPLICATIONS (ALL RARE IN EXPERT HANDS)
- Wound infection 1 to 4%.
- Sangrado <1%
- Pancreatitis <0.3%
- Bile leakage 0.7% Bile leakage 0.7% Bile leakage 0.7% Bile leakage 0.7% Bile leakage
- Piedra retenida en Ducto común (colédoco) <5%
- Bile duct lesion 0.4%.
- Conversion to open surgery less than 5%. **
** Conversion should never be considered a failure, but rather a tool when Dr. Rosales decides that the laparoscopic approach could lead to unnecessary complications. Factors contributing to the need to convert to an open procedure are:
- Elderly patient
- American Society of Anesthesiologists (ASA) High Class
- Extreme obesity
- Thickened gallbladder wall
SURGICAL TECHNIQUE
SURGICAL TECHNIQUE (SIMPLIFIED EXPLANATION)
Under general anesthesia, a 10 mm incision is made in the umbilicus, CO2 is introduced into the cavity, then 3 more incisions are made in the abdomen (one of 10 mm and 2 of 5 mm) to introduce the rest of the instruments. The gallbladder and the structures that join it to the body are identified, stapled and cut, then the gallbladder is removed through one of the incisions, closed with sutures and the procedure is completed.
Incisions for Laparoscopic Gallbladder Surgery
FREQUENT QUESTIONS
It is a pear-shaped organ that stores bile produced by the liver and contracts or "squeezes" every time you eat to help with digestion, mainly of fatty foods.
No, your body can completely adapt to its absence without any consequences. Fat digestion will be normal after a couple of weeks.
Only two 5 mm and two 10 mm incisions and in very selected cases maybe even ONE.
Yes, but those staples are titanium, they don't hurt and can stay in your body forever.
You will be discharged the next morning after surgery.
Yes, just for the first couple of weeks, and easy to follow, since it is only a low-fat diet.
Would you like to receive personalized attention?
I will be happy to assist you personally!
Emergency and consultation: (878) 782 - 0900
Cell: 878-122-8833
Do not hesitate to send us your information, which will be kept confidential. We will be happy to help you.
info@drgabrielrosales.com
Rodrigo Andalón #112 Suite C Ground Floor
Colonia Burócratas,
Piedras Negras, Coahuila, Mexico. 26020
PIEDRAS NEGRAS MEDICAL CENTER