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Gallbladder Surgery

In people with symptomatic gallstones, laparoscopic cholecystectomy is recommended, consisting of minimally invasive surgery to remove the gallbladder.

How do gallstones form?

The insolubility of solid elements forms gallstones or biliary stones. Stones can be cholesterol or pigment stones.

In Western countries, about 80% of gallstones are cholesterol, and 15 to 20% are black pigments. Pigment stones are common in Asia.

Dr. Víctor Calao

Dr. Víctor Calao

Specialist in the timely diagnosis and immediate treatment of diseases of the gastrointestinal tract.

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These are some of the FAQs about Laparoscopic Gallbladder Surgery.

The gallbladder is a pear-shaped sac that measures 7 to 10 cm in length and has a capacity of 30 to 50 ml.

The gallbladder and bile ducts are organic structures of the digestive system, acting together to store and regulate bile flow. The gallbladder’s primary function is to collect and store hepatic bile and release it into the small intestine in response to a meal.

When the gallbladder is removed in surgery, it does not affect the patient’s health; it does not perform a vital function. The bile produced in the liver will then pass directly to the small intestine, no longer having a storage site.

Some people may experience nausea or vomiting in the first weeks when eating fatty foods, their system will adapt to this change, but it is advisable to reduce the intake of fatty foods.

The insolubility of solid elements forms gallstones. Gallstones can be cholesterol or pigment stones. In Western countries, about 80% of gallstones are cholesterol, and 15 to 20% are black pigments. Pigment stones are common in Asia.

The common primary event in stone formation is the supersaturation of bile with cholesterol. Cholesterol is insoluble in water and bile; that is, it does not mix with these elements. In other words, when there is a higher content of cholesterol, it concentrates, becomes sludge, and then solidifies.

Most of the time, gallstones in the gallbladder are multiple, variable-sized and hard, faceted or irregular, blackberry-shaped and soft. The colors vary from whitish-yellow and green to black.

The main symptoms are localized pain in the right upper quadrant of the abdomen (below the rib), pain in the pit of the stomach, pain in the right side, or running down the back.

This pain usually starts after eating fatty foods, dairy, nuts, avocado, eggs, etc. There may be nausea and vomiting. The pain is constant and increases in intensity for the first 30 minutes and lasts from 1 to 5 hours. The pain is episodic, that is, days or weeks can go by without pain.

The main symptoms are localized pain in the right upper quadrant of the abdomen (below the rib), pain in the pit of the stomach, pain in the right side, or running down the back.

This pain usually starts after eating fatty foods, dairy products, nuts, avocado, eggs, etc. There may be nausea and vomiting. The pain is constant and increases in intensity in the first 30 minutes, and lasts from 1 to 5 hours. The pain is episodic; that is to say, days or weeks can go by without pain.

In people with diabetes with symptomatic gallstones, cholecystectomy should be performed as soon as possible, as they are more prone to develop acute cholecystitis (active inflammation), which is often severe.

Laparoscopic cholecystectomy provides excellent long-term results.

In cases of acute cholecystitis, symptoms will persist for more than 24 hours, i.e., they will not improve with specific oral medication measures. Patients will require intravenous fluids, antibiotics, and analgesics.  However, the definitive treatment will still be gallbladder surgery. Early cholecystectomy within 2 to 3 days of illness is preferred to late cholecystectomy 6 to 10 weeks later.

An early cholecystectomy provides a definitive solution in one hospital stay, faster recovery time, and an earlier return to work.

More than 90% of cases in laparoscopic surgery are 3 small incisions that will only require washing during the regular bath with soap and water. Subsequently, they should be kept dry and covered with gauze. The stitches are removed in 7 to 10 days. It is essential that the patient starts with walks in the hospital and at home.

As laparoscopic surgery is a minimally invasive procedure, daily activities can be done from the first week. Just take care of the diet after gallbladder surgery as previously mentioned.

It is possible to have constipation after gallbladder surgery when the patient remains lying in bed for a long time without physical activity. The intestines slow down their movements and sometimes stop; even abdominal distension and pain may occur.

Some health conditions predispose to the development of gallstones: obesity, pregnancy, dietary factors, and high consumption of fatty foods, gastric surgery, intestinal resections, and hematological diseases such as thalassemia or sickle cell disease.

Women are three times more likely to form gallstones, and their first-degree relatives have twice the prevalence.

Gallstone disease is one of the most common problems that injure the gastrointestinal tract; prevalence in the general population is estimated at 11-36%.

The gallbladder surgery currently used is the laparoscopic approach, a minimally invasive method that only requires 3 to 4 incisions, measuring 5 to 10mm. This technique avoids a large incision previously used under the right rib, which led to the section of large muscle planes, which favored more significant post-operative pain and delayed recovery.

In laparoscopy, or some people mistakenly call it laser technique (no laser is used), cameras, lenses, and high definition monitors are used and unique instruments that allow maneuverability inside the abdomen, increasing the range of vision and decreasing the complication rate.

Besides being used in gallbladder surgery, we also use other types of laparoscopic surgery such as appendectomies, inguinal plasty, umbilical hernias, wall hernias (post-operative), hiatal hernia, reflux disease, cyst removal, intestinal resections, diagnostic methods of abdominal conditions, etc.

The standard diagnostic test for gallstones is abdominal ultrasound (ultrasound). Occasionally gallstones are recognized on abdominal X-ray or CT scan.

If the patient has typical symptoms, an ultrasound of the gallbladder should be performed before surgery to demonstrate gallstones. Patients with regular attacks who only demonstrate biliary sludge on two or more occasions and who suffer from recurrent episodes of abdominal pain may warrant cholecystectomy.

Diet after gallbladder surgery should remain low in fats and dairy products for the first 2 to 4 weeks since the ingestion of these foods may cause nausea, vomiting, or diarrhea. After this time, the body will get used to being without the gallbladder, and nutrient absorption will improve.

An early cholecystectomy provides a definitive solution in one hospitalization, faster recovery time, and an earlier return to work.

Fever in the first 24 to 48 hrs may be due to inadequate pain control, causing the patient not to breathe deeply, causing changes in the lung that generate an increase in temperature. If there is no adequate lung expansion, the fever will occur. Not to be confused with infection.

Fever occurring after one week should be investigated in detail in search of infectious processes. Any temperature elevation should be evaluated by the surgeon who operated on the patient since he/she knows the findings and the procedure performed and should include an extensive physical examination and detailed interrogation. Fever is defined as an increase in temperature above 38°C.

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