"To cut it or not" is a dilemma of people who have stones in the gallbladder. On the one hand, it plays an important role in digestion. On the other hand, the body is doing well without it. So what is the best option for gallstones? And if the follicle resection is better, laparoscopy or classic surgery is better?

The gall bladder often does not hurt

Often, stones in the gallbladder do not bother you. Then we can find out about them by accident, e.g. during an ultrasound of the abdominal cavity, when we want to check the condition of the kidneys or liver. At other times, they irritate the follicle mucosa, disrupting its work. A feeling of fullness or crushing in the area of ​​the right hypochondrium or in the upper abdomen may be a sign that the follicle is damaged.

It's enough to eat something fatty or just too much and it speaks up. Worse when the stone blocks the outflow of bile. Then you suddenly get severe pains (colic) on the right side of your abdomen, which may radiate to your shoulder blade or back. Usually they are accompanied by nausea, vomiting, flatulence. Sometimes there is also a fever.

If the deposits "sit still in the follicle", urolithiasis is usually not treated. But when they cause discomfort or bouts of colic, it is better to remove the follicle. This can be done laparoscopically or traditionally by dissecting the abdomen. Choosing a method will cure the severity of the disease and overall he alth. Both procedures are performed under general anesthesia.

Diagnosis of gallstone disease

A doctor recognizes gallstones by characteristic pain and an enlarged bladder, which gives an elastic resistance to pressure. However, to confirm the diagnosis, ultrasound of the abdominal cavity and blood analysis, the so-called liver tests. If the doctor has doubts about the location of the stones or suspects, for example, follicular cancer, computed tomography must be performed.

Important

When does the gallbladder need help?

If your ailments occur rarely and are not strong, you can save yourself, for example, No-Spa and Sylimarol. You should also be careful with your diet. If the pain recurs or the creasing lasts for a long time, consult a doctor. Jaundice requires a quick visit - it indicates a serious impairment of the liver.

When a colic attack lasts longer than 3hours, you need to call an ambulance. Persistent acute vesiculitis can lead to pancreatitis or inflammation of the peritoneum, for example.

Resection of the gallbladder: laparoscopy or traditional surgery?

If your doctor suspects that a stone is in the bile ducts, he or she orders endoscopic ascending cholangiopancreatography (ERCP). Under general anesthesia, an endoscope is inserted through the mouth where the bile duct opens into the duodenum and the bile duct is observed on a screen.

If the initial diagnosis is confirmed, the doctor pushes the stone into the duodenum (it is then expelled with the faeces). The treatment brings relief, but does not solve the problem because subsequent stones may block the bile ducts. Therefore, after the inflammation subsides, the vesicle with the remaining deposits must be removed.

According to an expertMichał Stępka, MD, PhD, gastroenterologist

Sometimes it's better to remove it, although it doesn't hurt

The most questionable question is what to do when a bubble full of deposits does not cause any symptoms. The prevailing view is that the risk of bladder cancer is slightly increased in people with gallstone disease. Such a hypothesis can be drawn on the basis of statistical data. Therefore, in order to prevent the development of the disease, surgeons sometimes suggest removing the follicle.

The indication for surgery is type 2 diabetes, because it promotes inflammation, and ultrasound findings, for example, thickened walls of the follicle, as it may indicate chronic inflammation, which sometimes leads to the development of neoplastic changes.

Removal of the gallbladder should also be considered when there has been a history of neoplastic diseases of the bile ducts in a close family.

Laparoscopic removal of bubbles is "easier" when the doctor does not expect any complications or complications. This method is not used in the acute stage, as adhesions after operations may be an obstacle. The doctor always advises that, if necessary, he will change to the traditional method during the operation.

4 small (approx. 1 cm) cuts are made on the abdomen, through which tools are inserted, e.g. endoscope. The operations begin with filling the peritoneal cavity with air. The abdominal shells rise, the belly feels like a balloon - this allows the doctor to observe the operating field and manipulate the instruments.

The arteries and cystic duct are closed with special clips (it is not ligated as in traditional surgery). The follicle is then excised and removed. On the day of the procedure, you can get out of bed. If there is no vomiting (a common reaction to anesthesia), your doctor will allow you to drink water. On the second day, dietary food is served and the patient leaves the hospital.After 10 days, the stitches are removed, and after 2 weeks, you can go back to work.

In acute conditions and when laparoscopy could cause complications, surgery is done traditionally. To get to the follicle, the doctor makes an incision under the right costal arch. You stay in the hospital 1-2 days longer than after laparoscopy, but the convalescence lasts about 4 weeks. Until the wound heals, you may have stomach ache.

You must do it

Check if you are at risk of urolithiasis

Stones are more often formed in women than in men. Every fourth 40-year-old has them. People who are genetically burdened, obese, and those on fasting or drastic slimming diets are particularly vulnerable. This problem is also more common in women who have given birth, take hormonal contraceptives or use HRT (high levels of estrogen in the blood contribute to the formation of plaque).

Diet after gallbladder surgery

Before the digestive system gets used to the fact that bile flows directly from the liver into the duodenum, for 4-6 weeks you need to be on an easily digestible diet: eat 4-5 meals a day, but in small portions, drink 2.5 liters water. Eat cooked, stewed food without any sauces at the beginning. From fruit - apples and pears without peel. Most people return to their regular diet after the removal of the follicle.

Other ways to get rid of plaque

Some people try to dissolve the stones with oral preparations to avoid surgery. Most doctors, however, are skeptical about this type of therapy. The stones dissolve slowly, and it takes months or even years to heal. In addition, only small cholesterol deposits are dissolved, without calcification, and not for everyone.

Even if the treatment is successful, there is no guarantee that new ones will not form. In turn, crushing stones with an ultrasound wave (lithotripsy) can cause serious complications (a piece of a pebble can get stuck in the bile duct and cause mechanical jaundice and even pancreatitis). For this reason, surgeons are against using this method.

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Category:

Gastrology