SINGLE INCISION LAPAROSCOPIC GALL BLADDER CHOLECYSTECTOMY

What is the Gall Bladder?

 

 

What are Gall Bladder problems / disease / illnesses?

 

  • Inflammation

 

Inflammation of the gallbladder is called Cholecystitis. Cholecystitis can be either chronic (long-term) or acute (short-term). Chronic inflammation is the result of several acute Cholecystitis attacks. Inflammation may eventually damage the gallbladder, making it lose its ability to function correctly.

 

  • Gallstones

 

 

 

 


 

  • Common Bile Duct Stones (Choledocholithiasis)

 

Gallstones can occur in the common bile duct. The common bile duct is the channel that leads from the gallbladder to the small intestine. Bile is ejected from the gallbladder, passed through small tubes, and deposited in the common bile duct. It’s then ushered into the small intestine.

 

In most cases, common bile duct stones are actually gallstones that developed in the gallbladder and then passed into the bile duct. This type of stone is called a secondary common bile duct stone, or secondary stone.

 

Sometimes stones form in the common bile duct itself. These stones are called primary common bile duct stones, or primary stones. This rare type of stone is more likely to cause an infection than a secondary stone.

 

  • Gallbladder Disease Without Stones

 

Gallstones don’t cause every type of gallbladder problem. Gallbladder disease without stones, also called acalculous gallbladder disease, can occur. In this case, you may experience symptoms commonly associated with gallstones without actually having stones.

 

  • Common Bile Duct Infection

 

An infection may develop if the common bile duct is obstructed. Treatment for this condition is successful if it’s found early. If it’s not, the infection may spread and become fatal.

 

  • Abscess of the Gallbladder

 

A small percentage of patients with gallstones may also develop pus in the gallbladder. This condition is called empyema. Pus is a combination of white blood cells, bacteria, and dead tissue. The development of pus leads to severe abdominal pain. If the condition isn’t diagnosed and treated, it can become life-threatening as the infection spreads to other parts of the body.

 

  • Gallstone Ileus

 

A gallstone may travel into the intestine and block it. This condition is rare but can be fatal. It’s most common among individuals over age 65.

 

  • Perforated Gallbladder

 

If you wait too long to seek treatment, gallstones can lead to a perforated gallbladder. This is a life-threatening condition. If the tear isn’t detected, a dangerous widespread abdominal infection may develop.

 

  • Gallbladder Polyps

 

Polyps are growths that develop. These growths are typically benign, or noncancerous. Small gallbladder polyps may not need to be removed. In most cases, they don’t pose any risk to you or your gallbladder. But larger polyps may need to be surgically removed before they develop into cancer or cause problems.

 

  • Porcelain Gallbladders

 

A healthy gallbladder has very muscular walls. Over time, calcium deposits can stiffen gallbladder walls, making them very rigid. This condition is called porcelain gallbladder. Those with this condition have a very high risk of developing gallbladder cancer.

 

  • Gallbladder Cancer

 

Gallbladder cancer is very rare. However, it can spread beyond the gallbladder quickly if it’s not detected and treated.

Signs & Symptoms

 

  • Pain

    • The most common symptom of a gallbladder problem is pain. This pain usually occurs in the mid- to upper-right section of your abdomen. It can be mild and intermittent, or it can be quite severe and frequent. In some cases, the pain will begin to radiate to other areas of the body, including the back and chest.

 

  • Nausea or Vomiting:

    • Nausea and vomiting are common symptoms among all types of gallbladder problems. But only chronic gallbladder disease may cause digestive problems, such as acid reflux, gas, nausea, and vomiting.

 

  • Fever or Chills:

    • An unexplained fever may signal that you have an infection. If you have an infection, you need treatment before it worsens and becomes dangerous. The infection can become life-threatening if it’s allowed to spread to other parts of the body.

 

  • Chronic Diarrhea:

    • Having more than four bowel movements a day for at least three months may be a sign of chronic gallbladder disease.

 

  • Jaundice:

    • Yellow-tinted skin may be a sign of a common bile duct block or stone.

 

  • Unusual Stools or Urine:

    • Lighter-colored stools and dark urine are possible signs of a common bile duct block.

How do you know if it’s something to worry about?

 

See a doctor immediately if you have:

 

  • Pain that may be caused by gallstones (continuous moderate to severe pain in the upper right abdomen) along with a fever of 100.4°F (38°C) or higher and chills that are clearly not caused by stomach flu or any other reason.

 

  • Pain in the upper midsection or upper right abdomen, along with a yellow tint to your skin and the white part of your eyes, dark yellow-brown urine, or light-colored stools.

 

  • Diabetes or an impaired immune system and you have symptoms that may be caused by gallstones.

 

  • If you have symptoms of gallstones but no fever, chills, or yellowing of your skin or the white part of your eyes, you may still require evaluation and treatment. Schedule an appointment with your doctor.

 

How is Gall Bladder disease diagnosed?

 

  • Liver function tests (LFTs), which are blood tests that can show evidence of gallbladder disease.

 

  • A check of the blood's amylase or lipase levels to look for inflammation of the pancreas. Amylase and lipase are enzymes (digestive chemicals) produced in the pancreas.

 

  • A complete blood count (CBC), which looks at levels of different types of blood cells such as white blood cells. A high white blood cell count may indicate infection.

 

  • The use of ultrasound testing which uses sound waves to image and make a picture of the intra-abdominal organs including the gallbladder.

 

  • An abdominal X-ray, which may show evidence of gallbladder disease, such as gallstones.

 

  • A computed tomography (CT) scan constructs a detailed X-ray images of the abdominal organs.

 

  • A HIDA scan. In this test, a radioactive material called hydroxy iminodiacetic acid (HIDA) is injected into the patient. The radioactive material is taken up by the gallbladder to measure gallbladder emptying function. This test also is referred to as cholescintigraphy.

 

  • Magnetic resonance cholangiopancreatography (MRCP), which uses magnetic resonance imaging (MRI) to produce detailed picture

 

  • Endoscopic retrograde cholangiopancreatography (ERCP), a procedure in which a tube is placed down the patient's throat, into the stomach, then into the small intestine. Dye is injected and the ducts of the gallbladder, liver, and pancreas can be seen on X-ray.

Treatment Options

 

In most cases, treatment of gallstones is considered necessary only if you are having symptoms. Of the various conventional treatments that are available, surgical removal of the gallbladder is the most widely used. Some alternative treatments have also been found to be effective in alleviating the symptoms of troublesome gallstones.

 

  • Conventional Medicine for Gallstones

 

When deciding what course of action to take for symptomatic gallstones, doctors usually choose from among three main treatment options: Watchful waiting, nonsurgical therapy, and surgical removal of the gallbladder.

  • Gallstones and Watchful Waiting

 

Though a gallstone episode can be extremely painful or frightening, almost a third to half of all people who experience an attack never have a recurrence. In some cases, the stone dissolves or becomes dislodged and thereby resumes its "silence." Because the problem may solve itself without intervention, many doctors take a wait-and-see approach following the initial episode.

 

Even when the patient has had repeated gallstone episodes, the doctor may postpone treatment or surgery because of other health concerns. If your surgery has been delayed, you should remain under a doctor's care and report any recurrences of gallstone symptoms immediately.

 

  • Nonsurgical Therapy for Gallstones

 

If you are unable or unwilling to go through surgery for a gallstone problem that requires treatment, your doctor may recommend one of several noninvasive techniques. Note that though these methods may destroy symptom-causing gallstones, they can do nothing to prevent others from forming, and recurrence is common.

 

Some gallstones can be dissolved through the use of a bile salt, although the procedure can be used only with stones formed from cholesterol and not from bile pigments. Medication can be taken too; depending on its size, the gallstone may take months or even years to go away, and often people need to take this medication indefinitely.

 

Another nonsurgical technique, shock wave therapy, uses high-frequency sound waves to fragment the stones. Bile salt is administered afterward to dissolve small pieces.

 

A method called contact dissolution can also be used to dissolve gallstones. The doctor inserts a catheter through the abdomen, and then injects a special drug directly into the gallbladder. In many cases, the stone disappears within a few hours. Contact dissolution and shock wave therapy are still considered experimental.

 

Doctors can also attempt to remove gallstones during an ERCP. During the procedure an instrument is inserted through the endoscope to attempt removal of the stone.

 

While these therapies may work for some, all of the above nonsurgical therapies are usually unsuccessful long term (since recurrence is common) and are rarely advised in clinical practice.

 

  • Surgery to Remove the Gallbladder

 

While the gallbladder serves an important function, it is not essential for a normal, healthy life. When gallstones are persistently troublesome, doctors often recommend removing the organ entirely. This operation is considered among the safest of all surgical procedures. Each year approximately 750,000 Americans have their gallbladder removed. It is also the only treatment method that eliminates the possibility that other gallstones will develop in the future.

 

When the gallbladder has been removed, bile flows directly from the liver into the small intestine, and this sometimes leads to diarrhea. Because bile no longer accumulates in the gallbladder, quantities of the digestive fluid cannot be stored up and used to break down an especially fatty meal. This condition is not considered serious, however, and can be corrected by simply limiting fat in the diet.

 

In the past, removal of the gallbladder was done through traditional "open" surgery, which requires surgeons to make a large incision in the abdomen. Patients faced a two- or three-day hospital stay plus several weeks of recovery at home.

 

Today, however, the most commonly used surgical technique is a much simpler approach known as laparoscopic cholecystectomy.

 

The most recent and least invasive technique is the Single Incision Laparoscopic (SILS) Cholecystectomy. In this technique pain is least as surgery is preformed through a single, small key hole-sized cut and there are no obvious scars, as the incision is made within the belly button. Benefits include:

 

  • Better cosmesis with no externally visible scar

  • Earlier return to activities of daily living

  • Earlier return to work

  • 1 incision instead of 4 hence, less pain

  • 1 incision instead of 4 hence less risk of related complications

Prevention

 

Although diet doesn't directly cause gallbladder problems -- and it won't cure them -- watching what you eat and keeping a healthy weight might help you prevent gallstones from forming and avoid some discomfort if you do develop gallstones.

 

  • Diet and Gallstone Risk

 

A number of risk factors contribute to the formation of gallstones, including a family history of gallstones and gender. Women are twice as likely as men to develop them. Body weight is also a factor; the risk of gallstones is higher in people who are overweight and obese.

 

Diets that are high in fat and cholesterol and low in fiber appear to play a role.

 

If you're overweight, try to lose the extra weight; but do it gradually. There is a link between quick weight loss and gallstone formation. Crash or "yo-yo" diets can cause the liver to release more cholesterol into the bile, disrupting the normal balance of cholesterol and bile salts. That extra cholesterol can form into crystals, leading to gallstones.

 

  • Healthy Food for the Gallbladder

 

Fresh fruits and vegetables

Whole grains (whole-wheat bread, brown rice, oats, bran cereal)

Lean meat, poultry, and fish

Low-fat dairy products

 

  • Certain foods have been studied for their potential to prevent gallbladder problems or reduce symptoms. For example, some research has indicated that drinking caffeinated coffee lowers the risk of gallstones in both men and women. Drinking moderate amounts of alcohol has also been linked to a reduced incidence of gallstones.

 

  • Foods to Avoid With Gallbladder Problems

 

Researchers say many gallbladder symptoms stem from the modern Western diet, which is high in refined carbohydrates and saturated fats.

 

Changing your diet won't get rid of gallstones that are already there, but eating a healthy, balanced variety of nutrients and limiting the amount of saturated fats and cholesterol-heavy foods you eat may help ease your symptoms.

 

Try to avoid or limit these high-fat foods in your diet:

 

  1. Fried foods

  2. Highly processed foods (doughnuts, pie, cookies)

  3. Whole-milk dairy products (cheese, ice cream, butter)

  4. Fatty red meat

 

Also steer clear of very low-calorie diets. If you are overweight, aim for a gradual weight loss of 1 to 2 pounds a week by sticking to a healthy, well-balanced diet and getting regular exercise. Always diet under your doctor's supervision.

 

 

 

Gallstones are small, hardened deposits that form in the gallbladder.

These deposits can develop and go undetected for years.

In fact, many people have gallstones and aren’t aware of them.

 

They eventually cause problems, including inflammation, infection, and pain. Gallstones typically cause short-term Cholecystitis.

The gallbladder is a 4-inch, pear-shaped organ. It’s positioned under your liver in the upper right section of your abdomen. The gallbladder stores bile, a combination of fluids, fat, and cholesterol. Bile helps break down fat from food in your intestine.

 

The gallbladder delivers bile into the small intestine. This allows fat-soluble vitamins and nutrients to be more easily absorbed into the bloodstream.