Surgical treatment of gallbladder stones

  The purpose of medicine is to relieve disease and improve the quality of human existence. Surgery is relative to internal medicine and mainly deals with lesions with the help of scalpel to achieve the purpose of curing diseases. Surgical diseases, whether they are trauma, infection, inflammation or tumor, are at different stages of development, and their local and systemic manifestations, treatment methods and prognosis of treatment are very different. For example, almost all tumors are completely curable in the early stage, but after the early stage, the possibility of complete cure decreases geometrically with the increase of the stage, or even impossible. Acute pyogranulomatous cholangitis can be cured by decisive surgical excision and drainage, but if the time is missed and multiple organ failure is reached, there is no point in surgery.  Gallbladder stones are a very common disease, and as far as the stones themselves are concerned, there is nothing remarkable, and today with laparoscopic techniques, they are not difficult to deal with. However, it is precisely the timing of the surgical intervention that makes a huge difference in the prognosis of the treatment. In the past, due to lack of awareness, patients and physicians waited until complications of gallbladder stones, such as acute cholecystitis, gallbladder necrosis or even perforation, common bile duct stones, and cholestatic pancreatitis of biliary origin, were present before removing the gallbladder. However, in this case, either the difficulty of cholecystectomy increases thus increasing surgical complications such as bile duct injury; or the lack of preoperative preparation leads to increased surgical deaths or the lack of preoperative detection leads to residual stones in the common bile duct after surgery; or the recurrent gallbladder inflammatory episodes cause extensive adhesions in the abdominal cavity, making laparoscopic cholecystectomy impossible, or even if the surgery is barely completed, the postoperative inflammatory process is complicated, resulting in postoperative intestinal adhesions and intestinal dysfunction; either because it has caused chronic pancreatitis, postoperative diarrhea is bound to occur. Our extensive clinical observations have revealed that all gallbladder stones, as long as there are no obvious symptoms before surgery, especially in patients without accompanying fever, have no sequelae after surgery. In the case of patients who had symptoms other than those common to gallbladder stones before surgery, these symptoms did not disappear after surgery, and seemed to be “moving constantly, static constantly”.  Therefore, in a certain sense, the treasure of surgical treatment: the first is timing, the second is timing, and the third is also timing.  Since the timing of surgery for surgical treatment has the significance of determining success or failure, then as a surgeon should be assigned the main responsibility. This responsibility is expressed in the continuous improvement of their academic and technical training, so that they have the ability to recognize and make the judgment of the timing of surgery, and at the same time have the ability to persuade patients and families to cooperate with the physician to solve problems with surgery. Of course the general public’s health popularity and the reconfiguration of the doctor-patient relationship will have an impact on the choice of surgical timing.