Gallbladder Removal Surgery
What is cholelithiasis?
It is the presence of stone in the gallbladder. Stones, or also called stones, are a major cause of gallbladder disease. The gallbladder is a small sac-shaped organ located close to the liver. It stores bile, a thick greenish-yellow liquid produced by the liver. After feeding, the gallbladder contracts, releasing bile to the intestine, which comes in contact with the food, continuing the digestion initiated by the stomach.
The basic function of bile is to digest fat and help absorb important nutrients such as vitamins A, D, E and K. Cholelithiasis is common in the population aged 20 to 60 years, especially in women.
How are gall stones formed?
Bile is excreted by the liver and travels through the bile ducts to reach the intestine. It is composed of water, cholesterol, bile salts, bilirubinate and lecithin. In equilibrium, these substances keep bile in a liquid state. When cholesterol, bile salts, or bilirubinates are produced in excess by the liver, it precipitates and forms small granules. These granules initiate the formation of gallstones.
The formation of these stones is more related to metabolic, hereditary and organic factors than to food intake, so food does not interfere much in this process.
Are all stones the same?
No, stones from cholesterol or bile salts can be found in the gallbladder; one or more stones; small stones such as sand or large grains.
About 90% of stones are formed from cholesterol. The remainder is made up of bile salts (bilirubinate). Pigmented stones, black or brown, are mainly formed by calcium bilirubinate.
What causes these calculi to form?
The cause of the formation of the stones is not well known. Some people who have blood problems related to red blood cell destruction are more likely to have gallstones because the gallbladder uses the destroyed red blood cells to produce excessive bile. There may be an increase in the secretion of cholesterol by the liver or the gallbladder may have some difficulty in emptying.
What are the risk factors?
Women of childbearing age, especially in their 40s.
Women who have had multiple pregnancies.
Obesity.
Marked weight loss: increases the loss of cholesterol in bile.
Use of oral contraceptives.
Pregnancy.
Sedentary lifestyle.
Advanced age.
Duodenal ulcers: cause a certain stasis of the vesicle, facilitating the formation of calculi.
Patients undergoing gastric surgery to treat cancer, ulcers or vagotomies may be more likely to form gallstones.
Chronic hemolytic anemia.
Use of parenteral diet.
How does a person with gallstones feel?
Many people with gallstones have no symptoms and are not even aware of this condition. Sometimes they discover these calculations when they are investigating some other pathology. For those who have symptoms, it is generally observed:
Intolerance when eating fatty foods such as fried foods, egg yolks, pies, fatty meats, etc.
Malaise and headache may be present.
In more acute conditions, there is intense, constant abdominal pain in the right side of the abdomen below the rib, close to the stomach or in the back. The pain is severe, sudden and localized and the abdomen becomes hard. Lasts from 30 minutes to 5 hours.
Nausea, vomiting often accompany abdominal pain.
When, in addition to pain on the right side of the abdomen, there is fever, chills and jaundice (yellow) it may be a case of acute cholecystitis, an acute inflammation of the gallbladder. In these cases, the urine may be dark (brown) and the stool pale.
What are the complications of cholelithiasis?
Biliary colic: This occurs when one of the stones becomes trapped in the outlet of the gallbladder, preventing the flow of bile, leading to significant distension and an effort to expel the stone. The result is colic-like pain.
Acute cholecystitis: when the stone is stuck right at the exit of the gallbladder for a prolonged period, the so-called acute cholecystitis occurs, an acute inflammation of the gallbladder with intense and constant pain, usually accompanied by fever.
Choledocholithiasis: is the result of the migration of a stone from the gallbladder to the common bile duct, which is the main channel that carries bile from the liver to the intestine, obstructing it. In these cases, the patient becomes jaundiced (the skin and whites of the eyes turn yellow) as the bile is prevented from reaching the intestine, accumulating in the liver and blood.
Cholangitis: it is the infection of the bile ducts by bacteria after the obstruction, since the stopped bile favors the proliferation of bacteria.
Pancreatitis: is inflammation of the pancreas. The channel that carries bile from the gallbladder to the intestine passes into the pancreas and joins the main channel that drains pancreatic juice. When the calculus obstructs these ducts, the pancreatic juice is retained and ends up attacking the pancreas itself.
Cholangitis and pancreatitis are the most serious complications.
How is cholelithiasis diagnosed?
The clinical history is very characteristic and guides the diagnosis. There is a history of severe, constant abdominal pain in the right side of the abdomen below the rib, near the stomach, or in the back. The pain is severe, sudden and localized, with a hardened abdomen. Lasts from 30 minutes to 5 hours. Nausea and vomiting often accompany abdominal pain.
See a surgeon to assess your symptoms. The most accurate test for diagnosis is abdominal ultrasound.
Radiological examinations can show stones, often when the patient is investigating another pathology. But the cholesterol stones (mostly) do not show up on the x-ray. Scintigraphy can also be used for diagnosis.
When the stone is suspected to migrate into the bile channel, it can be diagnosed and removed preoperatively through endoscopic retrograde cholangiopancreatography and endoscopic papilotomy, respectively.
Edited video of a cholecystectomy surgery performed by robotic platform. Da VinciXi System.