With the rapid improvement of the national standard of living, the incidence of gallbladder stones is increasing, which seriously affects people’s health and life. Gallbladder stones can often be completely cured if they are diagnosed and treated correctly in a timely manner. Unfortunately, there are many misunderstandings in the diagnosis and treatment of gallbladder stones, which affect the treatment effect of gallbladder stones.
Common misconceptions in the diagnosis and treatment of gallbladder stones include the following.
Myth 1: The gallbladder is an important organ that secretes bile, and without it, there would be no bile in the body. Therefore, removing the gallbladder will have a great impact on the digestive function.
This misconception is very common. This misconception actually includes the following three aspects.
First, bile is not secreted by the gallbladder, but by the liver. The main role of the gallbladder is to store and concentrate the bile secreted by the liver, and when eating, the gallbladder will reflexively discharge the bile in it into the intestine to participate in the digestion and absorption of food. It can be seen that the gallbladder is just a collection and distribution site for bile, similar to a reservoir.
It is not wise to treat gallbladder stones by removing the stones without removing the gallbladder. A gallbladder with stones, regardless of the severity of the gallbladder itself, has a high probability of developing stones again in the future. Especially if the gallbladder has a long history of stones, the gallbladder has often lost its function of storing, concentrating and excreting bile, and preserving a diseased gallbladder is equivalent to preserving a lesion, which makes it more likely to develop stones again in the future. Furthermore, the surgery to preserve the gallbladder and remove only the stones is more complicated than cholecystectomy.
After removal of the gallbladder, bile flows slowly into the duodenum directly through the common bile duct. Because of the lack of concentrated bile draining into the bile duct after meals, there is a certain impact on the high-fat and high-protein diet in the near future after surgery, which is more significant for those who eat large amounts of food at each meal (such as young adults and agricultural workers). After three months, there is a slight dilatation of the bile ducts, which corresponds to a compensatory effect on the storage function of the gallbladder, and the effect on the digestive function becomes seemingly negligible. In a follow-up of people who received gallbladder stones before the age of 30, we observed that the majority were able to resume their pre-surgical diet three months after surgery, with little difference in digestive function before and after surgery.
Myth 2: Gallbladder stones are a minor problem, and even if they are not treated, they will not cause much problem.
This misconception has caused many patients to “wait for the treatment of stones” or “not to treat stones” and eat various “losses”. In detail, these “losses” are large and small, and can be roughly divided into “small loss”, “medium loss”, “large loss” and “heavy loss”.
An attack of acute cholecystitis, suffering from pain, costing money, can be classified as eating “small loss”. If the patient pays enough attention to this “small loss” and actively treats it, the gallbladder stones will be “eradicated”, although it is a mending of the fold, it is also “a small loss to earn a big bargain”. The treatment of small stones in the gallbladder is a good idea.
If the smaller stones in the gallbladder come out of the cystic duct and enter the common bile duct, forming secondary bile duct stones and complications such as bile duct obstruction, jaundice, acute cholangitis and acute pancreatitis, then the patient has suffered a “mid-loss” because the condition is much more complicated than gallbladder stones, and laparoscopy alone is not enough for treatment. This often requires more complex treatment.
When acute cholecystitis evolves into gallbladder suppuration and perforation, and common bile duct stones further complicate severe cholangitis and severe pancreatitis, the condition becomes serious, and if the treatment is not timely, death may occur, and even if the treatment is successful, the patient is still passing by with death, and in this case, the patient can be considered to have a “big loss”.
Of course, gallbladder stones can also make you suffer a bigger “loss”, which we will call “heavy loss”, and that is gallbladder cancer. We have encountered many heartbreaking cases. Some patients found gallbladder stones for 10 years or even longer, misunderstandings haunted them and they did not treat them. When the symptoms became obvious and they had to seek medical attention, the condition was no longer simple gallbladder stones, but complications of gallbladder cancer. In this case, even with active treatment, the survival period can hardly exceed three years.
As we can see, gallbladder stones are never a minor problem and should be treated actively once diagnosed!
Myth 3: Gallbladder stones without symptoms do not need to be treated, and we should wait until there are symptoms.
Due to the popularity of ultrasound and other imaging tests, more than 1/3 of gallbladder stones are diagnosed without symptoms, called “asymptomatic” gallbladder stones. A significant proportion of gallbladder stones only manifest as postprandial discomfort in the stomach area and are treated as “stomach problems” for a long time. Theoretically, the so-called “asymptomatic” is only relative and temporary. With the development of gallbladder lesions and the gradual decrease of body resistance, gallbladder stones will eventually become symptomatic, so patients should not leave them alone because they are temporarily asymptomatic, and lose the best time for treatment. Treating gallbladder stones when they are asymptomatic is better than mending them before they happen!
Other gallstones myth 4: Small gallbladder stones do not need to be treated, wait until they grow up.
This is a very wrong view. From a professional point of view, the larger the gallbladder stones are, the safer they are, because stones with a diameter of more than 1 cm are neither easily stuck in the gallbladder duct, nor do they fall into the common bile duct, and complications such as acute cholecystitis and common bile duct stones rarely occur. Those who have various complications are mostly stones with a diameter of 5 mm or less. Therefore, small gallbladder stones are more dangerous and should be treated as early as possible!
Myth 5: A single gallbladder stone does not need to be treated, wait for more to grow.
It is true that when gallbladder stones are multiple, they are often of different sizes, more common and heavier than single gallbladder stones, more likely to cause various complications and more dangerous, and should be treated more actively, but this in no way means that single gallbladder stones do not need treatment. However, it does not mean that a single gallbladder stone does not need to be treated. A single stone can also cause various complications and can also cause patients to suffer from several of the above mentioned “losses”. As the symptoms of a single large stone are often not serious, it is easy for patients to become paralyzed and neglect treatment, which makes them suffer more easily. Clinically, gallbladder stones complicated by gallbladder cancer are often single large stones, but rarely multiple stones or small stones. Therefore, a single gallbladder stone, regardless of its size, should be treated actively.
Myth 6: Gallbladder polyp is just a polyp in the gallbladder and does not need treatment
Strictly speaking, real gallbladder polyps are not rare. What we often call gallbladder polyps is an ultrasound description of the early lesions of gallbladder stones, because it looks like polyps on ultrasound images, so it is described as gallbladder polyp-like changes. Therefore, we can consider gallbladder polypoid lesions as an early form of gallbladder stones.
Smaller gallbladder polypoid lesions (0.2-0.3 cm in diameter) are usually asymptomatic, rarely cause complications, do not require surgical treatment, and can be treated with clinical observation and some medical treatment, and some of them can disappear. If the diameter is above 0.5 cm, it is less likely to disappear. If the symptoms are more obvious or have a tendency to grow significantly, surgical treatment can be taken.
Therefore, it is not correct to treat gallbladder polyp-like changes as gallbladder polyps, and it is also incorrect to generalize that gallbladder polyp-like changes do not require surgical treatment.
Myth 7: Gallbladder stones in elderly patients are not treated as much as possible.
The treatment of gallbladder stones in elderly patients is a more complex clinical problem. On the one hand, because the resistance of the elderly body is lower and gradually decreases with age, the symptoms of gallbladder stones in the elderly are more frequent and heavier, and they are more prone to complications such as acute cholecystitis and cancer, so they should be treated more actively than young and middle-aged gallbladder stones. On the other hand, elderly patients often develop chronic diseases such as cardiovascular and cerebrovascular disorders, chronic lung damage, and diabetes mellitus, which make laparoscopic cholecystectomy more risky and should be more cautious in surgical decision-making.
The above two characteristics of gallbladder stones in the elderly constitute a contradiction, and this contradiction, if not handled properly, will produce two problems. One is that patients are too scared to undergo surgical treatment because of their age, and the stones are not treated, delaying the best time for treatment and causing serious complications. On the other hand, the special and dangerous nature of elderly patients is overlooked, leading to reckless surgery and some problems that should not occur. Currently, these two aspects are common and are in urgent need of solution.
The proper management of gallbladder stones in the elderly specifically requires the following principles. First, concomitant cardiovascular disorders, chronic lung damage, diabetes mellitus and other chronic diseases should be actively treated; when these comorbidities are well managed, the risk of gallbladder surgery will be significantly reduced.
On the other hand, all aspects of the perioperative period, such as preoperative examination, anesthesia, and surgery, should be addressed. Second, whether gallbladder stones in elderly patients require surgical treatment should be based on a combination of factors, and never only on age. If the gallbladder stones have more symptoms and more frequent attacks, which seriously affect the patient’s quality of life, even if they are older, as long as the major organs of the body do not have serious dysfunction, they should be actively treated surgically under the premise of ensuring that the physical condition is tolerable, and should not be treated because of choking.
In another case, if gallbladder stones need to be treated due to the combination of other systemic chronic diseases and cannot tolerate surgical trauma such as anesthesia, in this case, to ensure effective treatment while minimizing surgical trauma, gallbladder stone removal under local anesthesia can be considered. Of course, if the patient is already over 80 years of age and the gallbladder stones are asymptomatic or not heavy, surgical treatment should be avoided as much as possible.
Thirdly, the treatment of elderly patients depends to a large extent on the comprehensive conditions of the hospital and should rely on large general hospitals, especially hepatobiliary specialty treatment centers, as much as possible. Finally, it should be noted that the concept of old age is evolving. Before the 1970s, China usually limited the concept of old age to over 60 years old, and after the 1980s, the usual concept is over 65 years old, and in the future, with the improvement of the national health care level, the concept of old age may also be improved accordingly.
The concept of old age is relative, some senior patients, although the age of more than 80 years, but his (her) physiological condition may only be equivalent to the level of 70 years; on the contrary, some young and middle-aged patients, although the age of only 50 years, or 60 years, but his (her) physiological condition may have long entered the state of old age. Specifically, the choice of treatment plan for each individual should not only depend on age, but more importantly, on the physiological condition.
In conclusion, it is unwise to give up gallbladder stone treatment indiscriminately just because of old age.
Myth 8: Gallbladder stones can be treated by lithotripsy and lithotripsy
Both of these approaches are inadequate. In the late 1980s, we did an experimental study to screen some drugs that could dissolve gallbladder stones and found that some of them could indeed dissolve stones, but the damage to liver and kidney function was so great that such treatment was not worth the loss.
If lithotripsy is still somewhat justified, lithotripsy can only be called adding to the chaos. From the above description, you may have sensed an important point in hepatobiliary surgery, the most fearful thing about gallbladder stones is stone removal. The discharge of gallbladder stones from the gallbladder to the common bile duct means the complication of the disease, the small disease becomes a big disease, and the patient enters the stage of “danger”, so to speak, and various complications will follow. Many patients with gallbladder stones are treated with stone removal and the stones are stuck in the lower end of the common bile duct, inducing severe pancreatitis, resulting in a tragic situation where people are left with no money.
Myth 9: Laparoscopic removal of gallbladder is more dangerous than open surgery, and in order to be safe, traditional open surgery should be chosen.
Laparoscopic cholecystectomy only requires a small 0.5cm-1cm incision at the patient’s navel, and then two or three tiny 0.3cm incisions in the right upper abdomen to extend the laparoscopic instruments through these holes into the abdominal cavity and remove the gallbladder.
Laparoscopic cholecystectomy changes the conventional surgical approach to a certain extent, as the surgeon operates indirectly using the principle of leverage, and the image seen is only a two-dimensional image. In theory, laparoscopic cholecystectomy carries greater risks than conventional surgery. For experienced hepatobiliary surgeons, the complication rate of laparoscopic cholecystectomy is similar to that of conventional open surgery.
Laparoscopic cholecystectomy basically does not damage the blood vessels, nerves and muscles of the abdominal wall, and the scar after healing is very small and does not affect the appearance, and complications such as intestinal adhesion, intestinal obstruction and incision infection rarely occur after surgery. Moreover, the postoperative pain is light, the hospital stay is short and the body recovers quickly. Because of these advantages of laparoscopic cholecystectomy, this procedure has become almost the only choice for the surgical treatment of gallbladder stones.
Myth 10: Laparoscopic cholecystectomy is a minor surgery, like appendectomy, which can be done in any hospital.
A laparoscopic cholecystectomy usually takes only about 20 minutes to complete, so in terms of time, it is indeed not a major surgery. However, it is a very deep operation, and hospitals need to have a good reserve of talents, techniques and equipment, and surgeons need to have solid basic skills in hepatobiliary surgery and skilled laparoscopic techniques, and the slightest mistake will produce serious complications that are difficult to make up. Therefore, we say that laparoscopic cholecystectomy is a “minor surgery” that requires “major knowledge” and is never the same as appendectomy. Appendectomy can be carried out in all levels of hospitals, including township hospitals, and doctors at all levels, including interns, can operate; however, hospitals and doctors who carry out laparoscopic cholecystectomy must have the corresponding “great knowledge” and can never carry it out casually.