Do all cases of cholecystitis require surgery?
No, many simple cholecystitis and asymptomatic stone cholecystitis can be treated without cholecystectomy.
Which cholecystitis requires surgery? The main ones are.
1, gallbladder stones combined with acute cholecystitis attack, the condition is serious, the effect of conservative treatment is poor, especially if the stones are located in the gallbladder jugular abdomen or the gallbladder duct leading to impaction, bile stasis, gallbladder enlargement is obvious, early surgery is appropriate.
2.Cholangitis leads to gallbladder perforation and causes peritonitis.
3, Gallbladder perforation leads to internal fistula (duodenum or colon), which means that the gallbladder and the surrounding intestinal canal form a pathological channel and the intestinal contents drive in, leading to repeated infections.
4. Gallbladder stones combined with chronic cholecystitis, with symptoms such as recurrent upper abdominal pain, are recommended for surgery. For stones larger than 75px in diameter, surgery is recommended.
5.Surgery is recommended for recurrent attacks of cholecystitis, resulting in thickening of the gallbladder wall, especially restricted thickening, when malignancy (i.e. gallbladder cancer) cannot be excluded.
6.Surgery is recommended for elderly patients with many underlying diseases, even if they are asymptomatic, as soon as conditions allow, because once the acute attack is very risky.
To put it simply, gallbladder stones and cholecystitis that are asymptomatic and found incidentally by physical examination can be treated conservatively or can be followed up. Those with symptoms, especially those with stone impaction, gallbladder enlargement and fluid accumulation, which are difficult to improve with conservative treatment, or those with recurrent symptoms, those that have ruptured or formed fistulas, and those with the possibility of cancer, should be operated early.
What size of gallbladder stones need to be operated?
This question has actually been answered above, but we still encounter many patients in the clinic who will ask: My stones are small, can’t we look at them again and wait for them to grow up later?
Well, there is a close relationship between cholecystitis and gallbladder stones, but it must be pointed out that the severity of cholecystitis and the need for surgery are not really related to the size of the stones. Large stones do not necessarily cause symptoms, but more importantly, their location. A 1-2 cm diameter stone located at the base of the gallbladder may not necessarily have symptoms for the rest of its life. (remember, “follow up”, not just ignore it, review the ultrasound regularly, and consult immediately if there is acute abdominal pain). Very small stones of a few millimeters in diameter that become lodged in the neck of the gallbladder or in the gallbladder duct are likely to lead to acute cholecystitis and enlarged gallbladder fluid, and many will require surgical removal. Of course, stones over 3 cm in diameter still require early surgery.
What’s more important is that very small gallbladder stones or cholesterol crystals can easily fall into the common bile duct with bile all the way down, leading to common bile duct stones, cholangitis, or even biliary pancreatitis, which would be more than worth the loss.
Therefore, the key point of gallbladder stones is not the “size”, but the “location”!
How to decide whether to choose open surgery or laparoscopic surgery?
Generally speaking, your doctor will decide on your surgical plan based on the following.
1. the patient’s condition. The main concern is whether the patient’s cardiopulmonary status can withstand the pneumoperitoneal effects of laparoscopic surgery, and whether the surgical requirements can be met by laparoscopic methods. There is also a history of previous upper abdominal surgery, inflammation is relatively heavy patients will also increase the difficulty of laparoscopic surgery.
2, the technical level of the visiting hospital. The level of technology is also an important factor in choosing whether to use laparoscopy. For example, an inexperienced surgeon may have to use open surgery for acute cholecystitis, while for an experienced laparoscopic surgeon, acute gallbladder inflammation does not constitute a contraindication to surgery.
Of course, there is a golden time frame for acute cholecystitis, as will be discussed later. The second step is to keep the PTCD flowing, and then, after 3-4 weeks, the cholecystitis is relieved and the edema of the gallbladder subsides, a complete “cholecystectomy” is performed!
With the onset of medical technology, the development of laparoscopic-based minimally invasive surgery is becoming increasingly mature, not only gallbladder removal, inguinal hernia repair, but also radical surgery for gastric cancer, radical surgery for colon cancer, liver cancer resection, and pancreatic surgery can all be accomplished using laparoscopy, so simply in terms of technology, laparoscopic cholecystectomy is the internationally recognized gold standard surgery for decades. In this regard, it is important to fully believe in the opinion of the doctor, not in the next door’s Wang Da Ma.
Can laparoscopic open gallbladder be complete?
Many patients will think that surgery will open the stomach to see clearly, how can we see clearly by looking in the mirror! I would like to tell you that laparoscopy is just a tool, just like Chinese people use chopsticks and foreigners use knives and forks, they use different utensils to get food into their mouths. The laparoscope is such a “quick and easy” tool, with little trauma, quick recovery, and many wounds so small that they don’t require stitching, but its operation in the abdominal cavity and the scope of surgery are no different from open surgery.
Of course, there are physicians whose level of lumpectomy surgery is not yet mature, which may lead to relatively more postoperative complications, such as gallbladder duct stones and residual common bile duct stones. However, for a surgeon with considerable experience, the principles of surgical operation grasped are the same in laparoscopic surgery as in open surgery, and there is no case of incomplete surgery due to the use of laparoscopic techniques.
The only difference is that the laparoscopic surgery has a small puncture opening and we will put the cut gallbladder into a plastic bag to remove it. Sometimes the stone or gallbladder is too big and we will clip or cut it to remove it, but the cut must be intact and no piece of gallbladder or stone will remain!