1, which gallbladder polyps should be done to remove the gallbladder surgically?
There are two cases of gallbladder polyps that require surgical treatment, one is symptomatic, such as epigastric pain, indicating inflammation of the gallbladder. The second condition is asymptomatic gallbladder polyps, which also require surgical treatment if one of the following conditions is present.
(1) Polyps above 25px;
(2) polyps growing rapidly in a short period of time or multiple polyps;
(3) polyps growing in the neck of the gallbladder. However, it should be noted that some hospitals nowadays only do polypectomy and preserve the gallbladder. This type of surgery is not reasonable and is not internationally accepted. At present, the internationally accepted procedure is laparoscopic cholecystectomy.
2, all kinds of lithotripsy treatment should be cautious.
In more than 20 years of clinical work, I have never seen a case of cholelithiasis cured by herbal lithotripsy. What I have seen is repeatedly taking Chinese herbal medicine while having recurrent attacks, and finally cured by surgical removal of gallbladder. In fact, there is no clinical evidence of lithotripsy, lithotripsy and lithotripsy removal by herbal medicine in gallstone cases. Instead, gallbladder stones are embedded in the bile duct or pancreatic duct after discharge from the gallbladder, causing cholangitis, pancreatitis and jaundice but can be seen everywhere. Therefore, the public is advised to seek immediate medical attention for any gallbladder stones, and surgical removal of the gallbladder should be performed if there are symptoms of abdominal pain or evidence of cholecystitis.
3. The scope of laparoscopic cholecystectomy.
Laparoscopy is accepted by the majority of gallstone patients as a minimally invasive surgery with little trauma and quick recovery. However, laparoscopic cholecystectomy is a minimally invasive procedure that is more risky than open cholecystectomy if the indications for abuse are not mastered. Under what circumstances is laparoscopy not indicated?
(1) History of upper abdominal surgery;
(2) History of jaundice or pancreatitis;
(3) Gallbladder wall thickness exceeding 12.5 px or significant atrophy of the gallbladder;
(4) enlarged intra- and extra-hepatic bile ducts. The above four types of cases are best selected for open surgery.
4. Diagnosis and surgical treatment of acute pancreatitis with special features and international standards.
Over the past 20 years, our general surgery department, under the guidance of Professor Zhang Yingtian, has been in the leading position in the province in the diagnosis and surgical treatment of acute pancreatitis, which has been recognized by our peers and the majority of patients. Why is it recognized by the whole body academic community? The key reasons are distinctive and in line with international standards.
(1) In the diagnosis of acute pancreatitis, we are the first in China to introduce the internationally accepted pancreatitis score and develop this score to continuous score.
This research project has been appraised by provincial experts as the leading level in China;
(2) In the area of acute pancreatitis surgery, we were the first to create the zipper method and the three-liter bag temporary abdominal closure technique to treat the severe complications of acute severe pancreatitis. These two techniques were awarded the Science and Technology Achievement Award by the Provincial Health Department and Wuhan Municipal People’s Government respectively. Why is it recognized by the majority of patients? The key is the leading technology, high cure rate and low recurrence rate:.
(1) The characteristic surgery for the treatment of biliary pancreatitis, transduodenal Oddi sphincterotomy and angioplasty was awarded the Science and Technology Achievement Award of Wuhan Municipal People’s Government;
(2) Meaningful and advanced pancreatitis treatment routines that are in line with international standards, as well as an intensive care unit with advanced instruments, which enables the standardized treatment of severe pancreatitis.
5.Surgical treatment of gallstone with low recurrence rate.
Recurrence of cholelithiasis after surgery is a headache for patients. 20 years, according to foreign literature and our clinical experience, the general surgery department pays special attention to improving the recent cure rate and reducing the long-term recurrence rate in the treatment of cholelithiasis, so that the mortality rate is reduced to zero.
(1) Standardized cholecystectomy: laparoscopic cholecystectomy or open cholecystectomy is chosen depending on the patient’s condition;
(2) Intraoperative choledochoscopy is routinely done in all cases of suspected bile duct obstruction;
(3) According to the different nature and location of gallstones, we choose different biliary drainage procedures that are most suitable for patients, such as choledochoduodenal anastomosis, choledochojejunostomy or transduodenal Oddi sphincterotomy, etc. In the past 10 years, statistics of nearly 10,000 cases of biliary surgery show that the 10-year recurrence rate is less than 1% and there are no cases of surgical death.
6.Laparoscopic surgery based on open gallbladder surgery in thousands of cases.
Laparoscopic cholecystectomy is a minimally invasive procedure that has emerged in the past 10 years. The development of this procedure has brought good news to the majority of gallstone patients, with little trauma, fast recovery, proper operation, and few complications if the indications are accurate. However, because laparoscopic surgery depends on two major technologies, one is laparoscopic technology, and the other is electrocautery and electrocoagulation technology, it requires a high level of surgeons, and according to foreign experience, it is almost impossible to perfect the mastery of laparoscopic technology without clinical experience of more than a thousand open gallbladder surgeries.
And if laparoscopic surgery is not mastered, once complications occur, it is much more terrible than open surgery, such as bile duct injury and recurrence of cholelithiasis. Our general surgeon who does laparoscopic surgery has the title of full professor and has more than one thousand cases of open surgery experience, thus guaranteeing that the rate of laparoscopic cholecystectomy in more than one thousand cases is below 2%, the recurrence rate is zero, and there is no complication of bile duct injury.
7.Treatment of gallstone disease
Asymptomatic gallbladder stones do not require treatment. Such gallstones are often found during physical examination by ultrasound and are called “stationary” gallstones, so a wait-and-see attitude should be adopted. However, if symptoms occur and are found to be caused by gallstones, they should be treated promptly.
Surgery is the most effective and therefore the most commonly used gallstone treatment. Surgical removal of the gallbladder removes the source of the gallstones. However, in the case of primary bile duct stones, removal of the gallbladder is not sufficient and another bile duct intestinal anastomosis is required.
It is reasonable that many patients are afraid of surgery and seek non-surgical treatment options. However, there are only two types of non-surgical treatments with proven evidence and effectiveness to date. One is oral ursodeoxycholic acid, which is taken daily for six months and is very expensive in aggregate. The problem remains that it is limited to cholesterol stones and is only effective for single stones less than 1.5 cm in diameter, otherwise it is ineffective; half of those whose gallstones disappear completely within 10 years after stopping the drug will have a recurrence of gallstones.
This drug can dissolve cholesterol stones in the gallbladder, so it was considered a good drug and a great invention when it was first used 20 years ago, but it is rarely used after a long time. There are many other commercially available bile acid drugs that do not have this litholytic effect, but still claim to treat gallstones. Ursodeoxycholic acid is also useless in the case of calcium bile pigment stones and primary bile duct stones. This drug is widely available and marketed, mainly because it is a “good idea”, i.e., patients are afraid of surgery.
Another non-surgical treatment for gallbladder stones is to use extracorporeal ultrasound to focus on the gallstones and then break them up. If the gallstones in the gallbladder are large, they are not easily broken, and even if they are broken, they are not easily expelled, and there is a risk of injury to the adjacent normal tissues. Therefore, it is only used in combination with oral ursodeoxycholic acid in cases of cholesterol stones, which was popular for a while more than 10 years ago, but it has not stood the test of history.
In addition to removing the source of the gallstones, 95% of gallbladders with symptomatic gallstones have varying degrees of acute and chronic inflammation, or other problems with gallbladder contraction or bile concentration. In most gallbladder stones, the gallbladder is no longer functional, and removal of a non-functional gallbladder does not impede digestive function, so only some cases have a slight increase in stool frequency after surgery, but they return to normal after a few months.
Primary bile duct stones and gallstones draining from the gallbladder into the bile duct without access to the small intestine require surgical treatment. In addition to colic, this condition is associated with acute cholangitis infection, chills and fever, and jaundice, which can be very dangerous for the liver and the whole body. In a few cases, the bile ducts can be removed with a duodenoscopic electrodissection at the protrusion of the bile ducts into the small intestine, and then the gallstones can be trapped and removed; in most cases, the gallstones are too large and numerous to be removed, especially in primary bile duct stones. If there are stones in the intrahepatic bile duct and they cause symptoms of infection, biliary-intestinal anastomosis should be performed.
Isolated small stones in the intrahepatic bile ducts found by ultrasound during physical examination are not indicated for surgical treatment if they are asymptomatic.
In conclusion, cholelithiasis is a common and complex disease, and a short description is not enough to give a complete picture. In terms of surgery, there are laparoscopic and open surgery, each with its own surgical indications, which are not substitutes but rather complementary to each other.