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 10 cm long in the upper abdomen, and it takes 7 to 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 antibiotics. 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. The harm of gallbladder stones to human body mainly comes from several aspects: a, recurrent abdominal pain, which often appears after eating a fatty diet, or attacks at night, affecting life and study. The cause of episodic pain is that the stones block the gallbladder duct and cause gallbladder spasm. If the above symptoms are not controlled in time, the gallbladder may become edematous, purulent, or even perforated, and life-threatening. b, 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. c, stones enter the common bile duct to induce acute pancreatitis, which may cause severe abdominal pain. If pancreatitis is not controlled, it can be life-threatening. d, long-term repeated inflammatory stimulation can induce gallbladder cancer.
Therefore, once the diagnosis of gallbladder stones is confirmed, 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 whether there are other complications. The medication cannot solve the problem at the root, because the current medication for cholecystitis does not eliminate gallbladder stones, but can only reduce the inflammation to a certain extent, while the harm of gallbladder stones to the human body mainly comes from gallbladder stones and a series of problems caused by them.
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 during open surgery are still difficult to use during laparoscopic surgery. Therefore, laparoscopic surgery may not be suitable for patients with special circumstances, such as those with a history of previous upper abdominal surgery and heavy inflammation. However, whether gallstones can be solved laparoscopically depends largely on the skill level of the surgeon.
4. On what basis does the surgeon decide whether to perform laparoscopic or open surgery?
The choice of open or laparoscopic surgery depends on two factors: the patient’s condition and the surgeon’s skill. The patient’s medical 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 the laparoscopic approach. The skill level of the surgeon is also an important factor in choosing whether to use laparoscopy. For example, an inexperienced surgeon may have to use open surgery for acute cholecystitis, whereas 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 questions asked by patients with gallstones when choosing a surgical approach. 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 still immature, which may indeed lead to relatively more postoperative complications, such as residual gallbladder 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 the laparoscopic opening of the gallbladder is not complete, the open abdomen is equally incomplete!
6, must we operate if gallbladder stones are found?
Not necessarily! The treatment of any kind of disease should integrate many factors and treat people as a society. From a medical point of view, the treatment of gallbladder stones should take into account the patient’s age, the presence of other diseases such as cardiopulmonary disorders, diabetes, etc., as well as the presence of symptoms, the type and severity of symptoms, and so on. It is important to consider both the possible benefits and the possible risks associated with the procedure. Surgery is usually not recommended for elderly patients, or for patients with severe concomitant disease, if the gallbladder stones do not present with an uncontrollable condition, such as an acute gallbladder attack or pancreatitis, or obstructive jaundice. Doctors also generally do not aggressively recommend surgery for the average patient with asymptomatic gallbladder stones. After all, surgery carries certain risks.
7, Do I need surgery even if gallbladder polyps are found during physical examination but usually have no symptoms?
The so-called gallbladder polyp is a morphological diagnosis of ultrasound, which means that an abnormal polyp-like bulge is found in the gallbladder during the 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 tumor diameter of the gallbladder does not exceed 1.0 cm, the chance of its malignant transformation is small. Therefore, in clinical practice, physicians generally take 1.0 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 cause the patient to have corresponding symptoms in the postoperative period, such as diarrhea after greasy food, upper abdominal discomfort, etc.
8, will the stones recur after gallbladder removal for gallbladder stones?
Theoretically, gallbladder stones will not recur after cholecystectomy, because gallbladder stones have lost the ground for occurrence after cholecystectomy. The so-called “recurrence of stones after cholecystectomy” mainly refers to the following cases: 1, incomplete removal of the gallbladder, the residual gallbladder contains stones or recurrence of stones, mostly the former. 2, residual stones or recurrence of 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 only gallbladder removal is performed. Therefore, before gallbladder removal, the doctor should perform a detailed evaluation to exclude the possibility of stones in the common bile duct.
9. Can gallbladder stones cause pancreatitis?
Pancreatitis is one of the major complications of gallbladder stones and is caused by stones entering the common bile duct through the cystic duct. Pancreatitis caused by gallbladder stones is called “biliary pancreatitis”, which is usually relatively mild and can be relieved quickly with conservative treatment. Once gallbladder stones are accompanied by pancreatitis, the complexity and risk of treatment are greatly increased.
10, What are the consequences of not operating gallbladder stones?
Gallbladder stones without surgery may cause the following consequences: 1, gallbladder inflammation, recurrent epigastric colic, which can be relieved by antispasmodic and anti-inflammatory treatment. If the above treatment cannot be controlled, gallbladder inflammation will continue to worsen, abdominal pain can continue to develop, and fever may appear, and there may be serious complications such as gallbladder perforation.2, repeated inflammatory attacks and the role of stones can affect the bile ducts, or the emergence of gallbladder-duodenal, gallbladder-colon internal fistula, causing biliary obstruction, obstructive jaundice, cholangitis and other symptoms, the complexity of surgical treatment and complication rate will also The complexity of surgical treatment and the incidence of complications can be greatly increased.3, The occurrence of pancreatitis is seen previously.4, The long-term presence of stones irritating the gallbladder can lead to a significantly higher incidence of gallbladder cancer.
11. What are common bile duct stones?
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 by stones in the common bile duct, and stones in the intrahepatic bile duct can also enter the common bile duct. The main risk of common bile duct stones is that they can block the common bile duct and lead to jaundice, cholangitis or pancreatitis. Because of the risk of choledocholithiasis, the doctor will advise the patient to treat it as soon as it is diagnosed.
What should I do if my gallbladder stone is found in the bile duct?
Surgeons should rule out the possibility of common bile duct stones as much as possible before preparing a patient for cholecystectomy because any gallbladder stones can 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 either as an intermediate open procedure or laparoscopically. The disadvantage of this method is that it requires the placement of a T-tube for drainage, which is left in place for about a month.
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.