Gallbladder stones and gallbladder polyps are very common diseases, and many patients choose to have their gallbladder and stones or polyps removed together, becoming “gutless heroes”. However, the latest medical research proves that gallbladder removal can have many adverse effects on patients’ lives, and the chances of developing common bile duct stones and colon cancer are also increased.
JI Zhenling, head of the Biliary Surgery Group of Jiangsu Province and director of the General Surgery Department of the Affiliated Hospital of Southeast University, said that for a long time, it was widely believed that the gallbladder was just a bag, with only storage, contraction and excretion functions, and that it would still survive if cut off. However, research now proves that after gallbladder removal, patients will often suffer from indigestion, bloating, diarrhea and other symptoms. In addition, epidemiological statistics have found that patients who have their gallbladders removed are twice as likely to develop common bile duct stones as normal people.
JZL said that due to advances in surgical concepts and technology, complete removal of the gallbladder is no longer necessary for many benign gallbladder diseases. Doctors focus on preserving the organ and organ function when treating the disease. Nowadays, biliary surgery is a very advanced minimally invasive treatment, and stones and polyps can be completely removed at once, with little chance of recurrence.
Gallbladder stones and gallbladder polyps are very common diseases, and many patients suffering from these gallbladder diseases choose to have their gallbladders removed together with their gallbladders, becoming real “gutless heroes” during treatment. Should the gallbladder be cut? or preservation? It has always been a controversial topic in the medical community, domestic and international, the benevolent, the wise. But in recent years, the call for gallbladder preservation has become stronger and stronger.
The reporter learned today from CUH that from next week, the first biliary clinic in Jiangsu Province will be officially opened every Monday and Wednesday afternoon from August 5, led by Professor JI Zhenling, head of the Biliary Surgery Group of Jiangsu Province and director of the Department of General Surgery of CUH, Southeast University, and a doctoral supervisor. The chief physician, on the issue of bile preservation to clear up the confusion.
Why do we need bile preservation?
JI Zhenling introduced, due to the progress of surgical technology, many benign gallbladder diseases no longer necessary to remove all. Gallbladder stones (polyps) is a common disease, multi-morbidity, such a large number of patients can not simply everything up. While treating the disease, it is more important for doctors to preserve the organ and its function.
Academician Qiu Fazu, one of China’s leading surgeons, calls for “paying attention to the function of the gallbladder, playing the role of the gallbladder, and protecting its existence.” Academician Huang Zhiqiang pointed out that “we should pay attention to the exploration and research of gallbladder function”. This coincides with the common needs of modern people in general.
The endoscopic minimally invasive gallbladder preservation technique is now officially written in the medical school textbook of surgery edited by Professor Deyang Zhang. Domestic and international experts have further recognized the importance of preserving the gallbladder and have made technical breakthroughs.
Does gallbladder removal have any effect on human health?
For a long time, people have a superficial understanding of gallbladder stone disease, and generally believe that the gallbladder is just a bag, which only has the functions of storage, contraction and excretion, so it can survive as usual if it is cut off, and there is no big impact and it is dispensable. Especially since the development of laparoscopic cholecystectomy, most people think that minimally invasive technology has solved the problem of gallbladder stones, and that cutting the gallbladder is not negotiable.
If the gallbladder has been removed, when the patient eats, there will be no sufficient amount of bile to help, and the symptoms of indigestion, abdominal distension and diarrhea will occur. Moreover, the loss of bile reserve function after cholecystectomy causes bile to be continuously excreted into the duodenum from intermittent excretion caused by eating, and bile is retained in the duodenal bulb within 24 hours, increasing the chance of bile reflux into gastritis, which can easily lead to duodenal intestinal fluid reflux and reflux gastritis. In clinical practice, doctors often find that patients with common bile duct stones have a history of cholecystectomy. Epidemiological statistics show that the incidence of common bile duct stones is 2:1 when the gallbladder is removed versus not removed, and studies have shown an increased risk of colon cancer after cholecystectomy. In addition, preserving the gallbladder can eliminate chronic cholecystitis. In a group of patients with gallbladder stones and chronic cholecystitis, Beijing Hepingli Hospital conducted a follow-up study after cholecystectomy and found that, 1-2 years after cholecystectomy, the gallbladder wall changed from thick to thin in 84% of cases, and gallbladder contraction and visualization rate improved significantly. This indicates that the inflammation of the gallbladder is completely reversible and the inflammatory lesions can be eliminated.
How is biliary surgery performed?
Biliary conserving surgery is a very advanced minimally invasive treatment using laparoscopic combined with choledochoscopic approach. There is no visible scar on the abdomen after surgery, and even no scar can be seen. And because the laparoscope and cholangioscope can magnify the surgical field 10 times, very delicate stones and polyps can be clearly displayed, so stones and polyps can be completely removed at once without residue.
At present, there are fewer centers that carry out minimally invasive bile preservation treatment for gallbladder stones (polyps) at home and abroad. In China, centers such as Shanghai Oriental Hospital of Tongji University, Shougang Hospital of Peking University and Zhongda Hospital of Southeast University carried out earlier. CUH has completed more than 300 cases of biliary preservation surgery, and the overall efficacy is remarkable. Long-term follow-up reveals the advantages of less trauma, less scarring, high postoperative quality of life, low complication rate and low recurrence rate of stones (polyps) after surgery.
Which patients are suitable for biliary preservation?
Gallbladder polyps: more than 95% of gallbladder polyps in China are benign cholesterol polyps.
Gallbladder stones: 1-3 in number, less than 2cm in diameter, with good contractile function of gallbladder after examination.
Which patients are not suitable for biliary preservation?
Malignant lesions of gallbladder (gallbladder cancer, malignant polyps of gallbladder)
Gallbladder adenomatous hyperplasia
Gallbladder stones (multiple filled stones, giant stones)
Acute cholecystitis (septic, perforated, necrotizing)
Chronic cholecystitis (gallbladder wall thickening, gallbladder atrophy, gallbladder wall calcification)
What does the gallbladder do?
The gallbladder not only has the functions of storage, concentration, contraction and excretion, but also has the function of regulating the pressure in the bile ducts, and also has complex chemical and immune functions. The gallbladder can concentrate the dilute liver bile 30 times and store it in the gallbladder for high-fat diet before it is excreted into the intestine to participate in digestion.
In short, for the treatment of gallbladder stones or gallbladder polyps, there should be a change in concept, to be people-oriented, not only to remove the stones or polyps, but also to protect the existence of gallbladder function. For gallbladder disorders, doctors should first consider protecting the function of the human organ, maintaining the balance of the internal environment, removing stones or polyps and other diseases, and then consider gallbladder removal if necessary. Do not cut the gallbladder first, and do not remove the gallbladder for no reason on the pretext of prevention and convenience. This is the correct viewpoint for the treatment of gallbladder disease.