INSIDIOUS DANGER; GALLSTONES
The gallbladder is an organ that is just below the liver and, functions by storing bile, which is the liver’s secretion. One of the many functions of the liver is the production of bile. Bile removes toxic substances excreted from the liver through the intestine. Bile also has important roles in fat digestion. The liver produces bile for 24 hours, but after meals, a large amount of bile is required for digestion of fat, which is provided by the gallbladder.
The composition of bile contains cholesterol and various organic salts. The imbalance between these substances leads to the formation of gallstones. Gallbladder stone can usually cause a pain that starts in the upper right part of the abdomen after meals and can spread to the right shoulder and lower part of the right shoulder, which increases and decreases from time to time and goes on within a few hours. We call this type of pain as bile colic.
Who has gallbladder diseases?
Gallstones can be seen in diseases related to fat metabolism, and most commonly seen in blonde or brown-skinned, multiparous, overweight women. However, it can be seen in other patients who do not belong to this group.
Why do we call this as insidious danger?
In the past, stones that were found by chance and did not cause any complaint were called silent stones. This view is not accepted today. Because there is always an infection where the stone is. Although thought to be silent, this gallbladder disease is very dangerous with perforation of the sac (bile peritonitis) and small stones falling into the main bile duct causing obstructive jaundice, and pancreatitis caused by these small stones can have fatal consequences.
Gallbladder cancers are also seen in gallbladders with stones. Gall bladder should be removed as soon as possible to get rid of these life-threatening situations.
What happens if gallbladder diseases are not treated?
Gallstones can fall into the bile ducts if left untreated. In this case, various diseases may occur. Jaundice occurs when the bile ducts are blocked by gallstones. Bile begins to accumulate in the liver and may impair liver function in the long term, causing liver failure.More frequently, pancreatitis occurs as a result of obstruction of the pancreatic duct that opens into the intestine along with the bile duct.
Pancreatitis can cause a wide range of illnesses from mild discomfort to long-term intensive care and death. The most important reason for the operation of gallstones is not the pain of the patient, but to prevent life-threatening acute pancreatitis.
What are the treatment methods? Is there any treatment other than surgical intervention? For example, is it possible to crush the gallstones?
The treatment is surgical. It is removed together with the stone or stones in the gallbladder. Some methods used in kidney stones do not apply to gallstones. The treatment method for kidney stones is to separate them into small pieces and remove from the body with urine. The anatomy of the liver and biliary tract is different.
In this case, we do not want the stones to fall out, because the gallstones falling into the bile ducts can have more severe consequences. Due to its special anatomy, gallstones should be removed from the body before falling into the bile ducts.
Are there patients with gallstones at greater risk?
Yes, especially in diabetic patients, the gallbladder inflammation called acute cholecystitis is much more dangerous. Sensitivity of nerves decreases in diabetes. When the nerves do not function well and the gallbladder is inflamed, the patient’s pain starts late and is less felt.
Inflammation can lead to perforation of the gallbladder, flow the bile into the abdomen, and life-threatening conditions. Acute cholecystitis can be fatal in diabetic patients because of late recognition of inflammation. Therefore, the decision of surgery in diabetic patients is much more important.
What is the laparoscopic method used in gall bladder surgery?
Laparoscopy is the operation without entering a large incision through the holes created in any body cavity with the help of cameras and surgical instruments. For the gallbladder operation, the abdominal cavity is inflated with gas and the surgery is performed with the help of cameras and instruments entered from 4 incisions of 0.5 to 1 cm.
What are the advantages of laparoscopic gallbladder surgery compared to open surgery?
Since there are small holes instead of the incision line as the site of operation, it is both more aesthetically satisfactory, and the postoperative recovery process is faster.
How long can the patient return to daily life after laparoscopic surgery?
Normally, the patient is kept in hospital for observation for 1 day after surgery and is discharged the next day. In some centers abroad and in new studies, it is recommended that the patient can be discharged on the afternoon of the operation day. Selected low-risk cases can be discharged early in our country.
What should and should not do after gall bladder surgery?
Since bile is involved in fat metabolism, there may be vague symptoms of abdominal discomfort in a period of 2-3 months after surgery, but they return to normal (within 2-3 months) after the body has adapted to the new anatomy. Patients can continue their normal lives without restrictions.