Operations
Gall bladder
Every day we hear from friends, acquaintances or relatives around us saying that they have ‘stones’. They obviously mean that they have stones in the gall bladder. It is important to know exactly what happens to such a common problem because we all have bile, but “gallstones” have only a 10-25% of the population. Some are terrified, some are underestimated and they just don’t know how to deal with it. But let’s take a look at some basic parameters of the problem.
The gall bladder is a small pouch sized and shaped like a pear. It is located on the lower surface of the liver, on the upper right side of the abdomen. It is connected to the main bile drainage system with a small tube, the cystic duct. The main job of the gall bladder is to store and concentrate bile, which is produced and excreted by the liver continuously. After a greasy main meal, the gall bladder contracts and sends a thick bile into the intestine. This is to achieve digestion mainly of fats and vitamins. After the meal is over, the gall bladder relaxes and begins to refill bile.
Bile is a green liquid, containing bile salts, cholesterol, bilirubin and lecithin. The liver produces about 850 ml of bile daily.
How do we get gallbladder stones?
Stones are formed when any of the bile constituents (especially cholesterol or bilirubin) cease to be soluble (possibly due to over-saturation of the solution) and give rise to sediment and crystals. This forms the mud in the gall bladder and the stones. We do not know why some make gallstones and some do not. But we do know some factors that increase the risk of stones. Also, how it affects diet is unclear, but diets high in cholesterol and fat and low in fiber can increase the chances of gallstones.
Also, how it affects diet is unclear, but diets high in cholesterol and fat and low in fiber can increase the chances of gallstones. Thus, patients with severe liver disease or blood diseases often present with bilirubin stones. Most often, however, we find cholesterol stones, especially in women over 20 (especially pregnant) and men over 50, overweight people, people on express diets with rapid weight loss, and those taking drugs (such as contraceptives or medication for cholesterol).
However, in most cases there is no specific reason for the presence of gallstones except age or a family predisposition.
Cholelithiasis: Symptoms
The most typical symptom of gallbladder stones is severe constant pain in the upper right abdomen, with varying reflections (to the stomach, back, between the shoulders, right shoulder and elsewhere). It may take up from 15 minutes to hours, may be accompanied by nausea, vomiting or sweating and may be associated with fever and / or jaundice (yellowing). Pain episodes can come suddenly with the interval of weeks, months or even years of no pain at all.
The pain of cholelithiasis comes from blockage of the gallbladder’s duct by a stone. When the blockage is prolonged (for several hours) the gall bladder begins to inflame. This condition is called acute cholecystitis and is characterized by fever, prolonged pain and eventually exacerbation of the contents of the gall bladder. In this case, admission to the Clinic, medication and often emergency surgery are necessary. Other atypical symptoms of cholelithiasis are indigestion (bloating, rashes), diffuse nausea in the abdomen, especially after fatty meals, stool color disorder, stomach or back pain only.
More serious complications can occur when stones pass through the bile duct, that is, the tube that connects the liver to the intestine. Then it can cause severe inflammation in the bile duct and may cause acute cholangitis or ascending inflammation to reach the liver (liver) and create liver abscesses. If the stones clog the pancreatic duct (which sends the pancreatic fluid – enzymes – into the intestine) then it can cause a very life-threatening disease: acute pancreatitis. All of these situations are dangerous and should be treated with due diligence in a Clinic or Hospital.
Many people with gallstones have no symptoms, and they discover it by chance while testing for another reason. Every year 1-3% of the population will have biliary colic, while 20-33% of the patients will have symptoms over 20 years. Most patients have symptoms before they get complicated. After biliary colic, 3-9% of patients experience severe symptoms each year, 1-3% have severe complications and 3-8% undergo cholecystectomy. 50% of people with mild symptoms will have complications within 20 years.
How is Cholelithiasis diagnosed?
The most important part of the diagnostic process is getting a good patient history, describing the patient’s symptoms, and clinically examining the doctor. Additional blood tests are needed to check liver function and biliary drainage. A key element of the diagnosis is the confirmation of any suspicion by some imaging method.
The most commonly used are ultrasound and computed tomography (CT Scan). In exceptional cases, where stones have entered the common liver or biliary duct, MRCP or even the most invasive Endoscopic Reverse Cholangiopancreatography (ERCP) procedure may be required, where a similar examination is performed. the bile duct can be checked and cleaned. The choice of the appropriate method is up to the specialist physician who is responsible for investigating and solving the patient’s problem.
Τα πιο συχνά χρησιμοποιούμενα είναι το υπερηχογράφημα και η αξονική τομογραφία. Σε εξαιρετικές περιπτώσεις, όπου οι πέτρες έχουν εισέλθει στον κοινό ηπατικό ή χοληδόχο πόρο, μπορεί να απαιτείται MRCP (Μαγνητική Χολαγγειοπαγκρεατογραφία) ή ακόμα και η πλέον επεμβατική διαδικασία της Ενδοσκοπικής Ανάστροφης Χολαγγειοπαγκρεατογραφίας (ERCP), όπου ο χοληδόχος πόρος μπορεί να ελεγχθεί και να καθαριστεί.
Η επιλογή της κατάλληλης μεθόδου εξαρτάται από τον ειδικό ιατρό ο οποίος είναι υπεύθυνος για τη διερεύνηση και επίλυση του προβλήματος του ασθενούς.
Treatment/Therapy
Cholecystectomy is the surgery that is indicated in each case of cholelithiasis, or after episodes of lithic cholecystitis / cholangitis or pancreatitis. There is absolutely no other way to get the stones removed from the gallbladder. The application of lithotripsy, as is the case with large kidney stones, has no efficacy in bile and can, in turn, cause significant problems and complications. There are also no drugs that “break down” the stones. Cholecystectomy is primarily a precautionary procedure, since it is done to prevent all of the above mentioned complications.
Twenty to twenty-five years ago, cholecystectomy was done ‘open’, that is, with a large incision in the right upper abdomen. The patient had to stay in the hospital for 4-6 days after this operation, and suffered from severe post-operative pain. Now, Laparoscopic surgery, which is done by specialized and appropriately trained surgeons, has solved these open surgery problems.
Laparoscopic Cholecystectomy is done with 3-4 small holes in the abdomen, the patient stays in the hospital less than 24 hours, his mobilization and recovery is immediate, and the pain is almost non-existent.
Είκοσι έως είκοσι πέντε χρόνια πριν, η χολοκυστεκτομή γίνονταν «ανοιχτή», δηλαδή με μια μεγάλη τομή στη δεξιά άνω κοιλιακή χώρα. Ο ασθενής έπρεπε να παραμείνει στο νοσοκομείο για 4-6 ημέρες μετά από αυτή την επέμβαση και υπέφερε από σοβαρό μετεγχειρητικό πόνο. Τώρα, η λαπαροσκοπική χειρουργική, η οποία γίνεται από εξειδικευμένους και κατάλληλα εκπαιδευμένους χειρουργούς, έχει λύσει αυτά τα προβλήματα της ανοικτής χειρουργικής επέμβασης.
Η λαπαροσκοπική χολοκυστεκτομή γίνεται με 3-4 μικρές οπές στην κοιλιακή χώρα, ο ασθενής μένει στο νοσοκομείο λιγότερο από 24 ώρες, η κινητοποίησή του και η αποκατάστασή του είναι άμεση και ο πόνος είναι σχεδόν ανύπαρκτος.
Laparoscopic Operations
- Laparoscopic cholecystectomy
- Laparoscopic appendicectomy
- Laparoscopic hernia repair
- TEP Laparoscopic procedure
- Femoral hernia
- Umbilical hernia
- Incisional hernia
- Midline hernia
- Sports hernia
- Laparoscopic hiatal hernia repair
- Laparoscopic achalasia repair
- Laparoscopic colectomy
- Benign colon disease (Diverticulitis)
- Malignant abdominal diseases
- Laparoscopic splenic liver or renal cyst removal
- Laparoscopic adhesions
- Diagnostic Laparoscopy
