Gallstone disease is one of the most common diseases in hepatobiliary surgery, summarizing several issues of most concern to patients in clinical practice, and share with you. Due to the limited tools at hand, will just look at the sketch! 1, gallbladder stones, to open or not to open? Young patients, with small stones and no symptoms, can be suspended without surgery, pay attention to diet and regular follow-up review; patients with symptoms of right upper abdominal pain and discomfort, especially those with recurrent attacks, are in principle recommended to have surgery; elderly patients with more underlying diseases, even if asymptomatic, are recommended to have surgery as early as possible, because once the risk of acute attack is great; those with suspected risk of malignancy such as gallbladder atrophy found on physical examination, should have surgery as early as possible. 2.When is surgery more appropriate? It is generally recommended to operate when there is no pain, or 1-2 months after the inflammation is controlled for acute attacks.
It is more appropriate to open it after 1-2 months after the inflammation is controlled, because at that time the gallbladder is not inflamed and edematous, the operation is simple, the recovery is fast and the complications are few. If conservative treatment is not effective, emergency surgery is required, but the risk is much greater. 3. Minimally invasive, or open? I just want to say that one is a fine operation under 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 village lady next door. 4, how to do gallbladder removal surgery, minimally invasive can open clean? Look at the picture together. Just to clarify, the process of gallbladder removal is exactly the same for minimally invasive and open surgery. The difference is that the minimally invasive abdominal wall puncture opening is small, and we will put the gallbladder in a retrieval bag to remove it. Sometimes, because of too many stones too large, or gallbladder edema, we will cut up the specimen to facilitate removal, but the gallbladder is removed to make sure it is complete, not piece by piece, and there will be no residue. 5.Can I have my gallbladder preserved? How is biliary lithotripsy done? B ultrasound or MRI and other imaging tests clearly single or few stones, intraoperative choledochoscopy or cholecystoscopy must be clear that there are no residual stones or sediment, otherwise, stone recurrence is the biggest pain after biliary preservation surgery. 6.What is the difference between bile duct stones and gallbladder stones? Keep looking at the picture, the growth location is different and some etiologies are different. Some of the bile duct stones are gallbladder stones falling 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. 7.Why is it necessary to put 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, so 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 strictures and bile leaks. Currently, the T-tube is usually left in place for 2-3 months, and can only be removed after there is no stricture or stone remaining on the imaging. 8.What is ERCP? There is an alternative treatment for common bile duct stones. The opening of the bile duct into the intestine is found through the gastroduodenoscope, and a retrograde tube is inserted to remove the stones from the bile duct. It is an excellent minimally invasive treatment because there is no need to incise the common bile duct 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. 9.What will be the impact of gallbladder removal on my life? The physiological function of the gallbladder is to concentrate and store bile, so a low-fat diet is required in the short term after gallbladder removal.
After 2-3 months, the bile ducts will be compensated to expand and play the role of part of the gallbladder, and then you can eat normally and have no impact on your life. Therefore, it is normal to find mild dilatation of bile ducts after cholecystectomy and there is no need to worry.