Why do gallbladder stones lead to common bile duct stones?
The common bile duct is the bile channel between the intrahepatic bile duct and the duodenum. Bile secreted by the liver enters the duodenum through the common bile duct, while the gallbladder is the temporary bile storage organ attached to the common bile duct. The so-called common bile duct stones are stones that appear in the common bile duct for various reasons, mostly due to gallbladder stones dislodged through the bile duct, but also stones that originate in the common bile duct, and stones from the intrahepatic bile duct can also enter the common bile duct.
For example, the gallbladder is a reservoir that receives bile produced by the liver every day and then concentrates and stores it. After each meal, it receives signals from both nerves and food and contracts to remove the bile, which is discharged into the duodenum and small intestine to aid digestion. Therefore, when there are stones or crystals in the gallbladder, it is very likely that the stones will be discharged into the common bile duct, especially after a full or fatty meal, but there is a “gate” (oddis sphincter) at the exit of the common bile duct near the duodenum, which blocks the way of the stones. This is the cause of most common bile duct stones.
The main danger 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, doctors recommend early treatment of the patient once it is diagnosed.
What should I do if my gallbladder stone is complicated by a common bile duct stone?
Generally speaking, doctors will try to rule out common bile duct stones before preparing a gallbladder for cholecystectomy. The doctor will assess the possibility of the patient having common bile duct stones based on the patient’s medical history, symptoms, laboratory tests and routine ultrasound and CT findings. In some cases, when the common bile duct is thickened during surgery, the surgeon may also use cholangiography to find out if there are also coexisting common bile duct stones.
Once the diagnosis of common bile duct stones is clear, the following methods are available for management.
1, open choledochotomy to retrieve the stone, this method is more stable, its disadvantage is that a T-tube needs to be placed to drain and left for about a month. Laparoscopic choledochotomy for stone extraction (combined with choledochoscopy).
2.Preoperative removal of common bile duct stones by ERCP, followed by laparoscopic cholecystectomy, which is often referred to as “double-scope surgery”. The advantage is that it is less invasive, but the disadvantage is that ERCP has certain complications, such as pancreatitis.
Can I have a biliary stone extraction?
Bile preservation! Again, gallbladder preservation!
I knew I couldn’t avoid the topic of biliary surgery when talking about gallbladder. I can only secretly sigh: some hospitals are too good at it, and the bidding ranking of a website is too dumb (when you search for cholecystectomy, the top ones must be “biliary surgery” in some high profile hospital). You must know: laparoscopic cholecystectomy is the internationally recognized gold standard! Do you see foreigners doing biliary surgery? Look at so many hospitals in Shanghai, how many of them are doing biliary surgery?
Back to the topic, scientifically speaking, there are strict indications for choosing “biliary surgery”, such as: normal gallbladder function (concentration and excretion of bile) before surgery, non-recurrent gallbladder inflammation, no potentially malignant lesions in the gallbladder, and the patient’s willingness to undergo biliary surgery and accept the associated risks, especially the possibility of reoperation. In addition, in addition to normal surgical risks, biliary conserving surgery may also occur: postoperative traumatic acute cholecystitis, residual or missed polyps, postoperative biliary leakage, biliary peritonitis, abdominal adhesions, postoperative stones or recurrence of cholecystitis, etc.
Does removal of gallbladder affect the body?
In general, cholecystectomy does not have a significant impact on the body, especially when you are dealing with a pathological organ that has a “condition”, and laparoscopic cholecystectomy is less invasive than traditional surgery.
Generally speaking, the main conditions that may occur after cholecystectomy are: the bile is not concentrated in the intestine due to insufficient compensation in a short period of time, which may lead to excessive bowel movements in some patients (but this may be good news for constipated patients), which will be relieved as the bile duct compensates and intestinal reabsorption increases; the feeling of fullness in the upper abdomen after a full meal and indigestion, especially after eating a fatty diet. Therefore, it is advisable to have a light diet in the short term after surgery, and open the diet gradually according to your condition. However, six months to a year after cholecystectomy, the digestion and absorption of fat will be improved through compensatory dilation of the common bile duct and changes in the activity rhythm of the gastroduodenum.
Best time to perform laparoscopic cholecystectomy for acute cholecystitis: the golden 48 hours
In acute cholecystitis, a growing body of research findings supports early treatment with laparoscopic cholecystectomy (LC). Early LC has been shown to reduce the number of days in the hospital and the cost of treatment for patients with acute cholecystitis. Daniel D. Tran et al. from Howard University conducted one of the largest population-based retrospective studies to date (95,523 patients), with results published in the December 2014 issue of JAMA of Surgery.
The study divided patients into three groups based on the time from admission to LC: Group 1 consisted of patients who had LC within 0-1 day of admission (61,576, 64.5%), Group 2 consisted of patients who had LC within 2-5 days of admission (30,838, 32.3%), and Group 3 consisted of patients who had LC within 6-10 days of admission (3,109, 3.3%). The results of the study showed that the incidence of urinary tract infection and pneumonia was significantly higher in group 2 patients compared to group 1 patients, and the incidence of postoperative infection, urinary tract infection and pneumonia was significantly higher in group 3 patients; the cost of treatment gradually increased as the time to perform LC was delayed.
Further analysis of patients who underwent LC within 0-5 days showed that patients who underwent LC within 0-2 days of admission had the lowest mortality rate, and those who underwent LC after 2 days of admission had a significantly higher mortality rate; and as the timing of LC was delayed, the incidence of postoperative complications gradually increased, as did the cost of treatment.
This study showed that LC within 48 hours of the onset of acute cholecystitis was safe and significantly associated with better clinical outcomes and lower treatment costs; delayed LC was significantly associated with higher complication rates and mortality, longer hospital stays, and higher medical costs. Therefore, delayed LC should be avoided in the absence of compelling reasons.