LITHIUM CHRONIC CHOLECYSTITIS
(STONES IN THE GALLBLADDER)
Between 5 and 15% of the western population presents biliary lithiasis (stones in the gallbladder). The majority of the stones are composed of cholesterol and form inside the gallbladder, from where can migrate to the bile duct, eventually causing obstructive pictures. The diagnosis of biliary lithiasis is based on clinical, analytical and imaging data. The first diagnostic test to perform is abdominal ultrasound, very sensitive for the diagnosis of cholelithiasis. In most of the times, cholelithiasis is asymptomatic and does not require any specific treatment. When it gives rise to symptoms or complications, cholecystectomy is indicated. Extraction is recommended of any diagnosed choledocholithiasis, even if it is asymptomatic, given the seriousness of its potential complications (cholangitis and acute pancreatitis).
Cholecystectomy is surgical excision of the gallbladder. The surgery is done to remove the gallbladder due to the presence of gallstones, which cause pain or an infection.
Common symptoms are:
* Sharp pain in the upper right side of the abdomen that can go to the back, middle abdomen or right shoulder
* Low fever
*Nausea and feeling of bloating
* Jaundice (the skin turns yellow) if there are gallstones blocking the bile duct.
Laparoscopic cholecystectomy: The gallbladder is removed with instruments that are placed in small incisions in the abdomen.
Open cholecystectomy: The gallbladder is removed through an incision in the right side below the rib cage.
Non-Surgical Procedure: Endoscopic removal of stones:
For asymptomatic gallstones
Benefits and risks of the surgery
Removal of the gallbladder will relieve pain, treat the infection and, in most cases, prevent gallstones from recurring. Possible risks include: Loss of bile, bile duct injury, bleeding, infection of the abdominal cavity (peritonitis), fever, liver injury, infection, numbness, elevated scars, hernia in the incision.
Risks of not performing a surgery:
There is a possibility of continued pain, worsening symptoms, gallbladder infection or outbreak, serious illness and possible death.
This technique is the most common for a simple cholecystectomy. The surgeon will make many small incisions in the abdomen. Ports (hollow tubes) are inserted into the openings. Surgical tools and a camera with light are placed in the ports. The abdomen is inflated with carbon dioxide gas so that seeing internal organs is easier. The gallbladder is removed and the openings of the ports are closed with sutures and surgical clips.
Open laparotomy. The procedure takes approximately one hour.
The surgeon makes an incision approximately 6 cm long on the upper right side of the abdomen and cuts through the fat and muscles until it reaches the gallbladder. The gallbladder is removed, and all ducts are stapled. The site is closed with staples or sutures. A small drainage can be placed from the inside to the outside of the abdomen. Drainage is usually removed at the hospital.