Gallbladder stones, to open or not to open? For young patients, if the stones are small and asymptomatic, surgery can be suspended, pay attention to diet, and follow up regularly; for patients with symptoms of right upper abdominal pain and discomfort, especially those with recurrent attacks, surgery is recommended in principle; for elderly patients and those with underlying diseases, even if they are asymptomatic, surgery is recommended as soon as possible, because the risk of acute attack is great; for those with suspected risk of malignant transformation such as gallbladder atrophy found on physical examination, surgery is recommended as soon as possible. When is it appropriate to operate? Generally, it is recommended to operate when there is no pain, or 1-2 months after the inflammation is controlled if there is an acute attack.
It is more appropriate to open the gallbladder after 1-2 months after the inflammation is controlled, because at that time the gallbladder is not inflamed and edematous, and the operation is simple, with quick recovery and few complications. If conservative treatment is not effective, emergency surgery is required, but the risk is much greater. Minimally invasive, or open? I would just like to say that one is a delicate operation with a high-definition magnified view many times, and the other is a deep, small incision to pull out by hand. There is no doubt that laparoscopic cholecystectomy has been the international gold standard for decades. Of course, those who have difficulty operating laparoscopically still need open surgery as a supplement, and the incision must not be small at that time. Trust the doctor, not the lady in the next village. How is cholecystectomy done and is it minimally invasive enough to open cleanly? Just to clarify, the procedure of gallbladder removal is exactly the same for minimally invasive and open surgery. The difference is that minimally invasive has a small puncture opening in the abdominal wall, and we will remove the gallbladder in a retrieval bag. Sometimes, because of too many stones that are too large, or because of gallbladder edema, we will cut up the specimen to facilitate removal, but the gallbladder is removed to make sure it is intact, not piece by piece, and there will be no residue. Can I have my gallbladder preserved? How is biliary lithotripsy done? Imaging tests such as B ultrasound or MRI clearly identify single or few stones, and intraoperative choledochoscopy or cholecystoscopy must clearly identify the absence of residual stones or sediment; otherwise, stone recurrence is the biggest pain after biliary preservation. What is the difference between bile duct stones and gallbladder stones? Continuing with the diagram, the location of growth is different and some of the etiologies are different. Some bile duct stones are gallbladder stones that fall into the bile duct through the gallbladder duct, called secondary bile duct stones, while primary bile duct stones have a higher recurrence rate. Common bile duct stones may cause bile duct obstruction and affect liver function, etc. In principle, surgery is recommended for all of them. Why is it necessary to put a drainage tube for bile duct stone surgery? Because the bile duct is the only way for the bile secreted by the liver to enter the intestine, bile duct stones cannot be simply removed like gallbladder stones. When the bile duct is incised to remove the stone and then sutured, the healing process may cause biliary stricture because of the constriction of the incision, so we routinely leave a
This is why we routinely leave a T-tube in the bile duct to prevent stricture and bile leakage. Currently, the T-tube is usually left in place for 2-3 months and is removed only when there are no strictures or stones remaining on the imaging. What is ERCP? An alternative treatment for common bile duct stones is to find the opening of the bile duct into the intestine through the gastroduodenoscope, insert the tube retrograde, and remove the stones from the bile duct. It is an excellent minimally invasive treatment because no incision of the common bile duct is required and no drainage is left in place. We recommend that patients with gallbladder stones combined with bile duct stones can be treated in two steps, starting with
ERCP to remove the bile duct stones and then laparoscopic cholecystectomy to achieve the least trauma and fastest recovery. However, the cost is relatively high and ERCP does not guarantee 100% success. How will gallbladder removal affect my life? The physiological function of the gallbladder is to concentrate and store bile, so a low-fat diet is required for a short period of time after gallbladder removal.
After 2-3 months, the bile ducts will be compensated and dilated to play the role of part of the gallbladder, and then the diet can be basically normal and has no effect on life. Therefore, it is normal to find mild dilatation of bile ducts after cholecystectomy and there is no need to worry.