1.What is the difference between laparoscopic cholecystectomy and traditional open surgery?
The main difference between laparoscopic cholecystectomy and traditional open cholecystectomy is its minimally invasive nature. In terms of recent results, traditional open surgery requires an incision about 10cm long in the upper abdomen, and it takes 7-9 days to remove the stitches after surgery, with obvious postoperative wound pain, longer recovery time for intestinal function, and longer time for postoperative rehydration and antibiotic use. Laparoscopic surgery, on the other hand, avoids the above disadvantages. Usually, you can get out of bed on the same day after laparoscopic cholecystectomy, and you can be discharged from the hospital about 3 days after surgery. In addition, laparoscopic surgery also avoids many wound-related complications, such as wound infection, fat liquefaction, incisional dehiscence, incisional hernia, etc., which occur at a higher rate in open surgery, especially in some patients with obesity and diabetes.
2.Can gallstones be treated with medication without surgery?
The causes of gallstones are very complex, and there is no effective prevention method yet. Gallbladder stones are harmful to human body mainly from several aspects: recurrent abdominal pain, which often occurs after eating a fatty diet, or at night, affecting life and study. Episodes of pain are caused by stones blocking the gallbladder duct and causing spasm of the gallbladder. If these symptoms are not controlled in time, the gallbladder may become edematous, septic, or even perforated, and become life-threatening. Stones in the gallbladder enter the common bile duct through the cystic duct, causing blockage of the common bile duct, leading to obstructive jaundice and can be complicated by severe cholangitis. Stones entering the common bile duct induce acute pancreatitis, which may result in severe abdominal pain. If pancreatitis is not controlled, it can be directly life-threatening. Long-term repeated inflammatory stimulation may induce gallbladder cancer.
Therefore, once a diagnosis of gallbladder stones is made, a specialist should be consulted as soon as possible to take appropriate treatment. The standard treatment for gallbladder stones is cholecystectomy, but the specific treatment should be considered according to the patient’s age and the presence of other co-morbidities. The medication cannot solve the problem at the root, because the current drugs for cholecystitis cannot eliminate gallbladder stones, but can only reduce the inflammation to a certain extent, and the harm of gallbladder stones to human body mainly comes from gallbladder stones and a series of problems caused by it.
3.Can all gallstones be solved by laparoscopic surgery?
No! Both laparoscopic surgery and open surgery are aimed at removing the gallbladder. Due to the limitations of laparoscopic surgery, many techniques used in open surgery are difficult to use in laparoscopic surgery, so patients with special circumstances, such as a history of previous upper abdominal surgery and heavy inflammation, are not necessarily suitable for laparoscopic surgery. But whether gallstones can be solved by laparoscopy depends largely on the skill level of the surgeon.
4. On what basis does the surgeon decide whether to use laparoscopic surgery or open surgery?
The choice of open or laparoscopic surgery depends on two factors: the patient’s condition and the surgeon’s skill level. The patient’s condition depends on whether the patient’s cardiopulmonary status can withstand the pneumoperitoneal effects of laparoscopic surgery and whether the surgical requirements can be met by laparoscopic methods. The technical level of the doctor is also an important factor in choosing whether to use laparoscopy. For example, an inexperienced doctor may have to use open surgery for acute cholecystitis, while for an experienced laparoscopic surgeon, acute cholecystitis does not constitute a contraindication to surgery.
5. Is laparoscopic opening of the gallbladder incomplete?
This question is one of the most common problems for patients with gallstones when choosing a surgical method. The reason for this concern is, on the one hand, the psychological effect of the patient, who believes that surgical treatment opens the stomach in order to see clearly, and how can one see clearly by looking in the mirror! On the other hand, the surgeon’s grasp of the surgical operation may be more conservative when his level of lumpectomy surgery technology is not yet mature, which may indeed lead to relatively more postoperative complications, such as residual bile duct stones, common bile duct stones, etc.
In fact, for a surgeon with considerable experience, the principles of surgical operation are the same in laparoscopic surgery as in open surgery, and there are no cases of incomplete surgery due to the use of laparoscopic techniques. Laparoscopic technology has been developed in China for nearly 20 years, and laparoscopic cholecystectomy technology has become very mature. Therefore, if laparoscopic open gallbladder is not complete, open abdomen is also not complete as well!
6.Gallbladder polyps found during physical examination, usually no symptoms, also need surgery?
The so-called gallbladder polyp is a morphological diagnosis of ultrasound, which means that there is an abnormal polyp-like bulge in the gallbladder found during ultrasound examination. Gallbladder polyps are usually cholesterol crystals in nature, which may develop into gallbladder stones over time. Gallbladder polyps may also be a tumor, but the relative percentage is not high. The nature of gallbladder polyps cannot be identified on ultrasound examination. Therefore, the main thing to consider in patients with asymptomatic gallbladder polyps is their risk of neoplasia. Numerous data show that when the diameter of tumor of gallbladder does not exceed 0.5 cm, its chance of malignant transformation is very small. Therefore, in clinical practice, physicians generally take 0.5 cm as the standard, and as long as the polyp diameter does not exceed this standard and the patient is asymptomatic, he or she can continue to be observed for follow-up. The usual follow-up strategy is to check ultrasound every six months, and once polyps are found to be rapidly increasing in size, especially single polyps, or polyps combined with stones, prompt surgical treatment should be performed.
For patients with symptomatic gallbladder polyps, the indications for surgery should be relaxed. It should be noted that the gallbladder of patients with gallbladder polyps is usually functional, and once the gallbladder is removed, it may lead to corresponding symptoms in the postoperative period, such as diarrhea after greasy food, upper abdominal discomfort, etc.
7.Will gallbladder stones recur after gallbladder removal?
Theoretically, gallbladder stones will not recur after gallbladder removal, because gallbladder stones have lost the ground for occurrence after gallbladder removal. The so-called “recurrence of stones after cholecystectomy” mainly refers to the following cases: incomplete removal of the gallbladder, stones in the residual gallbladder or recurrence of stones, mostly in the former case. Residual or recurring stones in the common bile duct. Gallbladder stones can enter the common bile duct through the cystic duct, and stones in the common bile duct are bound to remain if the gallbladder is only removed.
8.Can gallbladder stones cause pancreatitis?
Pancreatitis is one of the major complications of gallbladder stones, which is caused by stones entering the common bile duct through the gallbladder duct. Pancreatitis caused by gallbladder stones is called “biliary pancreatitis”, which is usually relatively mild and can be relieved quickly through conservative treatment. Once gallbladder stones are accompanied by pancreatitis, the complexity and risk of treatment are greatly increased.
9.What are the consequences of gallbladder stones without surgery?
The possible consequences of not operating gallbladder stones include: gallbladder inflammation, recurrent epigastric colic, which can be relieved by antispasmodic and anti-inflammatory treatment. If these treatments cannot be controlled, the gallbladder inflammation will continue to worsen, abdominal pain may continue to develop, and fever may appear, and serious complications such as gallbladder perforation may occur. Repeated inflammatory episodes and the role of stones can affect the bile ducts, or the development of gallbladder-duodenal or gallbladder-colon internal fistula, causing biliary obstruction, obstructive jaundice, cholangitis and other symptoms, and the complexity of surgical treatment and the incidence of complications can be greatly increased. The occurrence of pancreatitis is seen before. The long-term presence of stones stimulating the gallbladder can lead to a significantly higher incidence of gallbladder cancer.
10.What is common bile duct stone?
The common bile duct is the bile channel between the intrahepatic bile duct and the duodenum. Stones in the common bile duct are usually caused by gallbladder stones dislodged through the cystic duct, but also stones in the common bile duct and stones in the intrahepatic bile duct can also enter the common bile duct. The main danger of common bile duct stones is that they can block the common bile duct and lead to jaundice, cholangitis or pancreatitis. Due to its harmful effects, once diagnosed, the doctor will advise the patient to deal with it as soon as possible.
11.What should I do if the gallbladder stone is found in the bile duct?
Surgeons should rule out the possibility of common bile duct stones before preparing a gallbladder for cholecystectomy because any gallbladder stones may be combined with common bile duct stones. Based on the patient’s history, symptoms, laboratory tests, and routine ultrasound findings, the surgeon will assess the possibility of coexisting common bile duct stones and may recommend further MRI or even ERCP if necessary. During surgery, the surgeon will also use cholangiography to find out if there are also coexisting common bile duct stones depending on the intraoperative situation. Once the diagnosis of common bile duct stones is clear, the following methods are available for management.
a. Excision of the common bile duct to retrieve the stone, which can be done in an intermediate open procedure or under lumpectomy. This method is more stable and has the disadvantage that a T-tube needs to be placed to drain the stone and left for about three months.
b. Preoperative removal of common bile duct stones by ERCP, followed by laparoscopic cholecystectomy. The advantage is that it is less invasive. The disadvantage is that ERCP has certain complications, such as pancreatitis.