The gallbladder is a blind pouch, slender and curved, with the cystic duct connected to the bile duct. The gallbladder receives bile secreted by liver cells during fasting, concentrates it, and when people eat, the concentrated bile enters the intestine to aid in the digestion and absorption of food.
Gallstone disease is the most common lesion in the biliary system. Depending on the location, gallbladder stones, primary or secondary common bile duct stones, and extrahepatic or intrahepatic bile duct stones can be identified. In clinical practice, however, a single site is possible but not common, and several sites are often present in the same patient. In Europe and the United States, most gallstones are found in the gallbladder, and only a minority of cases (10% to 25%) originate in the bile ducts. However, in East and Southeast Asian countries, including China, especially in the vast coastal areas of China, the majority of gallstones (about 50%-90%) are primary bile pigment stones in the bile ducts. The morphology, size, and composition of gallstones generally vary significantly from site to site, so it can be assumed that the mechanisms of their formation are different, and the clinical symptoms and pathological manifestations will vary from person to person.
Classification and composition of gallstones
Gallstones can be classified according to their appearance as cholesterol, bile pigment, or mixed stones. However, in reality, the so-called cholesterol and bile pigment stones are not pure, therefore, strictly speaking, any stone is mixed.
Causes and mechanisms of gallstones
Bile retention
It is generally believed that bile retention is the primary condition for the formation of all kinds of gallstones, on the basis of which bile composition and metabolic changes will occur in the absence of inflammation and infection, eventually forming cholesterol stones, and mixed stones will form in patients with infection and inflammation.
Biliary tract infection
In addition to accelerating the absorption of bile salts by the inflamed gallbladder, which leads to a relative increase in the concentration of cholesterol in the bile and makes it easier to form precipitates, biliary tract infections can also contribute to the precipitation of cholesterol or bile pigments to form stones.
Metabolic abnormalities
The presence of hemolytic anemia and abnormal cholesterol metabolism can lead to stone formation.
Other factors
Generally speaking, gallstone occurs with age. Cholesterol stones tend to occur in women. Lifestyle and dietary habits can also contribute to the occurrence of gallstone disease. Some patients also suffer from gallstones due to long-term total parenteral nutrition.
Symptoms of Gallbladder Stones
The clinical symptoms of stones depend on size, location, presence of obstruction and secondary infection. Generally, larger gallbladder stones do not have special symptoms, and only occasionally feel distended and uncomfortable in the right upper abdomen, and some even have no symptoms at all, which is called “asymptomatic gallbladder stones”, while smaller stones can easily slide and obstruct the gallbladder duct or cause gallbladder neck impaction, causing acute cholecystitis and severe biliary colic. The typical symptom is pain in the right upper abdomen after a full meal, a greasy diet, and in some cases, pain in the right scapula and back. Smaller stones may also transfer into the common bile duct and form a triad of abdominal pain, chills and high fever, and jaundice.
Treatment of gallstones
Do I have to have my gallbladder stones removed?
More than 80% of gallbladders with stones will lead to cholecystitis and should be treated to prevent acute cholecystitis or other complications such as cholestatic pancreatitis induced by the formation of gallbladder stones. A small number of people may remain asymptomatic throughout their lives.
Gallbladder removal for symptomatic gallbladder stones is easily accepted by most people, while gallbladder removal for asymptomatic gallbladder stones is difficult for most people and is chosen to be left untreated. Here, we remind that early cholecystectomy is needed in cases of diabetes, long-term gallbladder stones, combined gallbladder polyps, porcelain gallbladder, and asymptomatic stones older than 60 years old, especially mud-like stones.
Important words again.
If you have diabetes, cardiovascular disease, gallbladder polyps or porcelain gallbladder, it is recommended to have your gallbladder removed as soon as possible, even if you have no symptoms.
Before preparing for your second child, please deal with gallbladder stones first!
The risk of gallbladder stones is related to their size, and small stones may be more likely to lead to serious complications because they are more likely to block the cystic duct or migrate to the common bile duct.
You have to be careful even if you don’t have any more gallstones!
How are gallstones treated?
Laparoscopic cholecystectomy is the first choice
Laparoscopic cholecystectomy is the first choice because of its small incision (tiny incision in the abdomen, 0.5cm to 1cm, known as “keyhole”), light pain (little pain, basically no scar, the operation is done under intravenous anesthesia, the patient completes the operation in a sleep state), fast recovery (reduce damage to surrounding tissues and interference with organ function, shorten the recovery time after the operation) and other advantages. It has become the standard procedure for cholecystectomy with the advantages of faster recovery (less damage to surrounding tissues and shorter recovery time).
The key point of knowledge must be asked: removing the gallbladder is not the loss of bile. The bile that helps the body digest is secreted by the liver, and the bile is still there after the gallbladder is removed.
What about intestinal cancer if you have your gallbladder removed? The person asking this question must be a senior Baidu enthusiast, because it involves uncommon terms such as stone bile acid, and if you dig deeper into this issue, the information obtained will also support gallbladder removal surgery.
Can I have a minimally invasive surgery when I have an acute gallbladder attack? Do I need an injection to reduce inflammation before doing it?
Minimally invasive surgery is still an option for acute cholecystitis, and many hospitals can successfully complete laparoscopic cholecystectomy in the inflammatory state. The injection to reduce inflammation does not necessarily reduce the difficulty and risk of surgery significantly.
Laparoscopic surgery is very mature
Can you save my gallbladder?
In fact, preserving a gall bladder is technically a trivial matter. Surgeons are reluctant to perform gallbladder preservation surgery because the constitution of gallstones formation has not changed and there is still a high recurrence rate of stones after surgery, especially when there is chronic inflammation of the gallbladder. If the conditions for bile-conserving surgery are met, the symptoms are usually not severe, and it is not necessary to remove the stones surgically.
Taking ursodeoxycholic acid after surgery may improve the ability of bile to dissolve cholesterol and reduce recurrence to some extent, but it is difficult to maintain the medication for a lifetime, and even continued medication cannot completely prevent recurrence.
Therefore, after weighing the pros and cons of cholecystectomy, doctors generally strongly recommend against bile preservation.
If you understand all the common risks of gallbladder preservation surgery, still insist on gallbladder preservation, and it is really necessary to remove stones, your doctor can perform minimally invasive gallbladder preservation surgery for you. Many people may not have had stones or a recurrence of cholecystitis for many years, but before surgery, you will need to be prepared for all the things you need to do for another surgery, including preparing your mind.
Of course, reoperation is still usually possible laparoscopically. There is a very small chance that you may need surgery for acute inflammation of the gallbladder before you are discharged from the hospital after biliary surgery.
To sum up this paragraph in one sentence: Biliary preservation is not a technical problem, but a problem of rationality.
Highly advanced robotic surgery, do I want an appointment?
Recently, da Vinci robotic surgery has also started to be used in gallbladder surgery. Compared with traditional surgery, da Vinci robotic surgery has three obvious advantages: real 3D images, which are clearer and more realistic than traditional laparoscopic surgery; breaking through the limitations of human hands, with 7 dimensions of operation, and also preventing the possible jittering phenomenon of human hands.
However, since laparoscopic gallbladder surgery is very mature and the procedure is relatively simple, there is generally no need to use such a high level technology.
Da Vinci surgery scene
Sorry, the stone fell into the bile duct, can it still be minimally invasive?
Yes! There are different minimally invasive treatment options, and there’s bound to be one that works best for you!
These include laparoscopic surgery, combined laparoscopic ERCP surgery, etc., which can be used for gallbladder stones combined with bile duct stones. Minimally invasive surgery is also available for recurrent stones that have a history of biliary surgery. Anatomy of the gallbladder Stones in different areas Filled stones