What are the potential complications of gallbladder removal surgery. How common are post-cholecystectomy symptoms. What should patients watch for after gallbladder surgery. When to seek medical attention following cholecystectomy.

Common Complications Following Gallbladder Removal Surgery

Gallbladder removal, also known as cholecystectomy, is generally considered a safe procedure. However, like any surgery, it carries some risks of complications. Understanding these potential issues can help patients be more prepared and vigilant during their recovery period.

Infection: A Post-Surgical Concern

One of the more common complications after gallbladder removal is infection. This can occur at the incision site or internally. Symptoms of infection may include:

• Increasing pain around the surgical area
• Swelling or redness
• Pus discharge from the wound
• Fever

If you notice these signs, it’s crucial to consult your healthcare provider promptly. A course of antibiotics is typically prescribed to address the infection and prevent further complications.

Bleeding: A Rare but Serious Complication

While uncommon, bleeding can occur following gallbladder removal. In most cases, minor bleeding stops on its own. However, significant bleeding may require additional surgical intervention to identify and stop the source.

Bile-Related Complications After Cholecystectomy

The gallbladder plays a crucial role in storing and releasing bile, a digestive fluid. Its removal can sometimes lead to bile-related issues.

Bile Leakage: An Uncommon but Significant Concern

During gallbladder removal, the tube connecting the gallbladder to the main bile duct is sealed with special clips. However, in about 1% of cases, bile can leak into the abdominal cavity. Symptoms of bile leakage include:

• Abdominal pain
• Nausea
• Fever
• Swollen abdomen

Treatment for bile leakage may involve draining the fluid or, in some cases, additional surgery to clean the abdominal cavity and repair the leak.

Bile Duct Injury: A Rare but Serious Complication

In rare instances, the bile duct itself can be damaged during gallbladder removal. This injury may be identified and repaired during the initial surgery. However, sometimes it’s only discovered later, necessitating a separate surgical procedure to correct the issue.

Potential Injuries to Surrounding Structures

The gallbladder’s proximity to other vital organs and structures means there’s a small risk of unintended damage during its removal.

Intestinal, Bowel, and Blood Vessel Injuries

The surgical instruments used in gallbladder removal can potentially injure nearby structures such as the intestines, bowel, or blood vessels. While rare, these injuries can occur. In most cases, if identified during the surgery, they can be repaired immediately. However, some injuries may only become apparent after the operation, requiring additional surgical intervention.

Post-Surgical Thrombosis Risk

As with any surgical procedure, there’s a risk of blood clot formation following gallbladder removal.

Deep Vein Thrombosis (DVT): A Serious Post-Operative Concern

Some individuals are at higher risk of developing blood clots after surgery, particularly in the leg veins. This condition, known as deep vein thrombosis (DVT), can be serious if the clot travels to the lungs, causing a pulmonary embolism. To mitigate this risk, patients may be given special compression stockings to wear post-operation.

Anesthesia-Related Risks in Gallbladder Surgery

While rare, complications associated with general anesthesia can occur during gallbladder removal surgery.

Potential Anesthesia Complications

Serious complications from general anesthesia are extremely rare but can include allergic reactions and, in very rare cases, death. The risk of anesthesia-related complications is significantly reduced in patients who are fit and healthy prior to the operation.

Post-Cholecystectomy Syndrome: Persistent Symptoms After Surgery

Some patients experience ongoing symptoms similar to those caused by gallstones even after gallbladder removal. This condition is known as post-cholecystectomy syndrome (PCS).

Understanding Post-Cholecystectomy Syndrome

PCS can manifest with symptoms such as:

• Abdominal pain
• Indigestion
• Diarrhea
• Flatulence

It’s believed that PCS may be caused by bile leaking into areas like the stomach or by gallstones left in the bile ducts. While symptoms are often mild and short-lived, they can persist for months in some cases. If you experience persistent symptoms, it’s important to consult your healthcare provider. Treatment options may include procedures to remove any remaining gallstones or medication to alleviate symptoms.

Alternative Remedies: The Gallbladder Cleanse Controversy

While not directly related to gallbladder removal complications, it’s worth addressing the topic of gallbladder cleanses, as some individuals may consider this alternative remedy before opting for surgery.

The Truth About Gallbladder Cleanses

A gallbladder cleanse, also known as a gallbladder flush or liver flush, is an alternative remedy claimed to rid the body of gallstones. However, there’s no reliable scientific evidence supporting its effectiveness in preventing or treating gallstones or any other condition.

Typically, a gallbladder cleanse involves consuming a mixture of olive oil, herbs, and fruit juice over several hours. Proponents claim this helps break up gallstones and stimulate their release. However, what people often mistake for passed gallstones are actually oil and juice globules formed by the cleanse ingredients.

Risks Associated with Gallbladder Cleanses

It’s important to note that gallbladder cleanses are not without risks. Some people experience:

• Nausea
• Vomiting
• Diarrhea
• Abdominal pain

Moreover, the ingredients used in these cleanses can present their own health hazards. If you’re considering any alternative treatments for gallbladder issues, it’s crucial to discuss them with a healthcare professional first.

When to Seek Medical Attention After Gallbladder Removal

Understanding when to seek medical help after gallbladder removal is crucial for ensuring a smooth recovery and addressing any potential complications early.

Red Flags After Cholecystectomy

Contact your healthcare provider immediately if you experience any of the following symptoms after gallbladder removal:

• Severe abdominal pain that doesn’t improve with prescribed pain medication
• Persistent nausea or vomiting
• Fever above 101°F (38.3°C)
• Yellowing of the skin or eyes (jaundice)
• Persistent diarrhea
• Dark urine or light-colored stools
• Redness, swelling, or discharge from the incision site

These symptoms could indicate complications such as infection, bile leakage, or other issues that require prompt medical attention.

Follow-Up Care After Gallbladder Surgery

Even if you’re not experiencing complications, it’s important to attend all scheduled follow-up appointments with your surgeon. These check-ups allow your healthcare team to monitor your recovery progress and address any concerns you may have.

Lifestyle Adjustments After Gallbladder Removal

While most people can return to their normal diet after recovering from gallbladder removal, some individuals may need to make dietary adjustments to manage digestive symptoms.

Dietary Considerations Post-Cholecystectomy

Consider the following dietary tips after gallbladder removal:

1. Gradually reintroduce fatty foods to your diet
2. Eat smaller, more frequent meals
3. Increase fiber intake to help normalize bowel movements
4. Stay hydrated to support digestion
5. Consider probiotics to promote gut health

If you experience persistent digestive issues, consult with a dietitian who can help create a personalized meal plan that accommodates your body’s needs post-surgery.

Physical Activity After Gallbladder Surgery

While it’s important to rest immediately after surgery, gradually increasing your physical activity can aid in recovery. Always follow your surgeon’s guidelines, but generally:

• Start with light walking as soon as you feel able
• Avoid heavy lifting for at least 2-4 weeks
• Gradually increase activity levels as you feel comfortable
• Listen to your body and don’t push yourself too hard

Regular, gentle exercise can help prevent complications like blood clots and promote overall healing.

Long-Term Outlook After Gallbladder Removal

Understanding what to expect in the months and years following gallbladder removal can help patients adjust to life without this organ.

Living Without a Gallbladder

The gallbladder is not an essential organ, and most people can live normally without it. However, some individuals may experience long-term effects:

• Occasional diarrhea or loose stools
• Difficulty digesting fatty foods
• Increased gas or bloating

These symptoms often improve over time as the body adjusts to the absence of the gallbladder. If symptoms persist or worsen, it’s important to consult with your healthcare provider.

Monitoring Liver Function

While the gallbladder is removed, the liver continues to produce bile. In some cases, your doctor may recommend periodic liver function tests to ensure your liver is functioning properly and to monitor for any potential issues related to bile production or flow.

Advances in Gallbladder Surgery Techniques

Surgical techniques for gallbladder removal have advanced significantly over the years, leading to improved outcomes and faster recovery times for patients.

Laparoscopic vs. Open Cholecystectomy

Most gallbladder removals today are performed laparoscopically, which involves making several small incisions rather than one large one. Benefits of laparoscopic surgery include:

• Shorter hospital stays
• Faster recovery times
• Less postoperative pain
• Smaller scars

In some cases, open surgery may still be necessary, particularly if there are complications or if the patient has had extensive previous abdominal surgery.

Robotic-Assisted Gallbladder Surgery

Some hospitals now offer robotic-assisted gallbladder removal. This technique allows for even greater precision during surgery. While outcomes are generally similar to traditional laparoscopic surgery, robotic assistance may be beneficial in complex cases or for patients with certain anatomical variations.

Psychological Aspects of Gallbladder Removal

While much focus is placed on the physical aspects of gallbladder removal, it’s important to address the psychological impact of surgery as well.

Managing Anxiety Before and After Surgery

It’s normal to feel anxious about undergoing surgery. Some strategies to manage this anxiety include:

• Educating yourself about the procedure and recovery process
• Discussing your concerns with your healthcare team
• Practicing relaxation techniques like deep breathing or meditation
• Seeking support from family, friends, or a support group

After surgery, some patients may experience mood changes or depression, particularly if recovery is challenging or if they experience ongoing symptoms. It’s important to communicate these feelings to your healthcare provider, as they can provide resources and support to help you cope.

Body Image and Surgical Scars

While laparoscopic gallbladder removal typically results in small scars, some patients may feel self-conscious about these changes to their body. It’s important to remember that scars will fade over time. If you’re concerned about the appearance of your scars, discuss scar management techniques with your surgeon or a dermatologist.

Future Developments in Gallbladder Disease Management

Research into gallbladder disease and its treatment continues to evolve, offering hope for improved management strategies in the future.

Emerging Non-Surgical Treatments

While gallbladder removal remains the gold standard for treating symptomatic gallstones, researchers are exploring non-surgical alternatives. These include:

• Improved medications to dissolve gallstones
• Advanced lithotripsy techniques to break up stones
• Novel minimally invasive procedures to remove stones without removing the gallbladder

While these approaches are still in development or have limited applications, they represent exciting possibilities for future gallbladder disease management.

Genetic Research and Personalized Medicine

Ongoing genetic research aims to identify individuals at higher risk of developing gallstones or experiencing complications after gallbladder removal. This could lead to more personalized prevention strategies and treatment approaches in the future.

As our understanding of gallbladder disease and its management continues to grow, patients can look forward to increasingly effective and personalized treatment options. However, for now, gallbladder removal remains a safe and effective solution for many individuals suffering from gallbladder issues.

Gallbladder removal – Complications – NHS

Removal of the gallbladder (cholecystectomy) is considered a relatively safe procedure, but like all operations there’s a small risk of complications.

Infection

Some people develop a wound or internal infection after a gallbladder removal.

Signs of a possible infection include increasing pain, swelling or redness, and pus leaking from a wound.

See your GP if you develop these symptoms, as you may need a short course of antibiotics.

Bleeding

Bleeding can occur after your operation, although this is rare. If it does occur, you may require a further operation to stop it.

Bile leakage

When the gallbladder is removed, special clips are used to seal the tube that connects the gallbladder to the main bile duct.

But bile fluid can occasionally leak out into the tummy (abdomen) after the gallbladder is removed.

Symptoms of a bile leak include tummy pain, feeling sick, a fever and a swollen tummy.

Sometimes this fluid can be drained off. Occasionally, an operation is required to drain the bile and wash out the inside of your tummy.

Bile leakage occurs in around 1% of cases.

Injury to the bile duct

The bile duct can be damaged during a gallbladder removal.

If this happens during surgery, it may be possible to repair it straight away.

In some cases, further surgery is needed after your original operation.

Injury to the intestine, bowel and blood vessels

The surgical instruments used to remove the gallbladder can also injure surrounding structures, such as the intestine, bowel and blood vessels.

This type of injury is rare and can usually be repaired at the time of the operation.

Sometimes injuries are noticed afterwards and a further operation is needed.

Deep vein thrombosis

Some people are at a higher risk of blood clots developing after surgery.

This is known as deep vein thrombosis (DVT) and usually occurs in a leg vein.

This can be serious because the clot can travel around the body and could block the flow of blood into the lungs (pulmonary embolism).

You may be given special compression stockings to wear after the operation to prevent this happening.

Risks from general anaesthetic

There are several serious complications associated with having a general anaesthetic, but these are very rare.

Complications include allergic reaction and death. Being fit and healthy before your operation reduces the risk of any complications occurring.

Post-cholecystectomy syndrome

Some people experience symptoms similar to those caused by gallstones after surgery, including:

This is known as post-cholecystectomy syndrome (PCS). It’s thought to be caused by bile leaking into areas such as the stomach, or by gallstones being left in the bile ducts.

In most cases symptoms are mild and short-lived, but they can persist for many months.

If you have persistent symptoms, you should contact your GP for advice.

You may benefit from a procedure to remove any remaining gallstones, or medication to relieve your symptoms.

Page last reviewed: 03 December 2018
Next review due: 03 December 2021

Gallbladder cleanse: A ‘natural’ remedy for gallstones?

What is a gallbladder cleanse? Is it an effective way to flush out gallstones?

Answer From Brent A. Bauer, M.D.

A gallbladder cleanse — also called a gallbladder flush or a liver flush — is an alternative remedy for ridding the body of gallstones. However, there’s no reliable evidence that a gallbladder cleanse is useful in preventing or treating gallstones or any other disease.

In most cases, a gallbladder cleanse involves eating or drinking a combination of olive oil, herbs and some type of fruit juice over several hours. Proponents claim that gallbladder cleansing helps break up gallstones and stimulates the gallbladder to release them in stool.

Although olive oil can act as a laxative, there’s no evidence that it’s an effective treatment for gallstones. Also, people who try gallbladder cleansing might see what looks like gallstones in their stool the next day. But they’re really seeing globs of oil, juice and other materials.

Gallbladder cleansing is not without risk. Some people have nausea, vomiting, diarrhea and abdominal pain during the flushing or cleansing period. The ingredients used in a gallbladder cleanse can present their own health hazards.

Gallstones that cause no symptoms typically require no treatment. If you have gallstones that require treatment, discuss proven treatment options with your doctor, such as surgical removal, bile salt tablets or sound wave therapy.

• Can you recommend a diet after gallbladder removal?

April 03, 2020

Show references

1. Rakel D, ed. Cholelithiasis. In: Integrative Medicine. 4th ed. Elsevier; 2018. https://www.clinicalkey.com. Accessed Feb. 10, 2020.
2. “Detoxes” and “cleanses”: What you need to know. National Center for Complementary and Integrative Health. https://nccih.nih.gov/health/detoxes-cleanses. Accessed Feb. 10, 2020.
3. Treatment of gallstones. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/digestive-diseases/gallstones/treatment. Accessed Feb. 10, 2020.

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Residual gallbladder stones after cholecystectomy: A literature review

J Minim Access Surg. 2015 Oct-Dec; 11(4): 223–230.

Pradeep Chowbey

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Anil Sharma

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Amit Goswami

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Yusuf Afaque

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Khoobsurat Najma

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Manish Baijal

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Vandana Soni

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Rajesh Khullar

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspeciality Hospital, Saket, New Delhi, India

Address for Correspondence: Dr. Anil Sharma, Max Institute of Minimal Access, Metabolic and Bariatric Surgery, Max Superspecialty Hospital, 1-2, Press Enclave Road, Saket, New Delhi – 110 017, India. E-mail: [email protected]

Received 2014 Oct 21; Accepted 2014 Oct 25.

Copyright : © 2015 Journal of Minimal Access Surgery

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

This article has been cited by other articles in PMC.

Abstract

BACKGROUND:

Incomplete gallbladder removal following open and laparoscopic techniques leads to residual gallbladder stones. The commonest presentation is abdominal pain, dyspepsia and jaundice. We reviewed the literature to report diagnostic modalities, management options and outcomes in patients with residual gallbladder stones after cholecystectomy.

MATERIALS AND METHODS:

Medline, Google and Cochrane library between 1993 and 2013 were reviewed using search terms residual gallstones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant and subtotal cholecystectomy. Bibliographical references from selected articles were also analyzed. The parameters that were assessed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up.

RESULTS:

Out of 83 articles that were retrieved between 1993 and 2013, 22 met the inclusion criteria. In most series, primary diagnosis was established by ultrasound/computed tomography scan. Localization of calculi and delineation of biliary tract was performed using magnetic resonance imaging/magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography. In few series, diagnosis was established by endoscopic ultrasound, intraoperative cholangiogram and percutaneous transhepatic cholangiography. Laparoscopic surgery, endoscopic techniques and open surgery were the most common treatment modalities. The most common sites of residual gallstones were gallbladder remnant, cystic duct remnant and common bile duct.

CONCLUSION:

Residual gallbladder stones following incomplete gallbladder removal is an important sequelae after cholecystectomy. Completion cholecystectomy (open or laparoscopic) is the most common treatment modality reported in the literature for the management of residual gallbladder stones.

Keywords: Cystic duct remnant, gallbladder remnant, post-cholecystectomy syndrome, residual gallstones, retained gallbladder stones, subtotal cholecystectomy

INTRODUCTION

Laparoscopic cholecystectomy is now the gold standard for treatment of symptomatic gallstones. In some patients however the symptoms may persist even after surgery. These include upper abdominal pain, dyspepsia with or without jaundice. A small percentage of patients with post-cholecystecomy syndrome are symptomatic due to a residual stone in a particularly long cystic duct or to the relapse of lithiasis in a gallbladder remnant.[1,2]

Incidence of incomplete gallbladder removal following conventional cholecystectomy appears very low.[3,4] In the laparoscopic era, incidence of unintentional incomplete gallbladder removal has not been reported clearly though it seems to be slightly more than the ones reported with open cholecystectomy.[5,6,7,8,9,10,11,12,13,14,15] Incomplete resection of gallbladder occurs in up to 13.3% of laparoscopic cholecystectomies.[16] Reasons for incomplete resection include poor visualization of gallbladder fossa during surgery, adhesions, concurrent inflammation, excessive bleeding, or confounding gallbladder morphology such as a congenital duplication or an hour glass configuration due to adenomyomatosis.[9,17]

Diagnosis and management of retained calculi can be challenging. Most of the patients with retained calculi require surgical intervention. Our aim is to review the literature for residual gallbladder stones after cholecystectomy, discuss diagnosis and management strategies in these patients.

MATERIALS AND METHODS

A protocol for a review of the literature was developed including search methods, literature review and criteria to select the studies assessed. The review used the Medline, Google and Cochrane library between 1993 and 2003. The following search terms were used: Residual gallbladder stones, post-cholecystectomy syndrome, retained gallbladder stones, gallbladder remnant, cystic duct remnant, subtotal cholecystectomy. Secondary searches of selected articles and reviews were performed. Full-text sources were available for most titles; however some data was derived from abstracts alone. The bibliographical references of each of these articles considered were also analyzed to find other articles that contributed to our review. The review included all the relevant publications in English language.

Two authors separately reviewed titles and abstracts obtained from search using a predefined data extraction form. Articles were retrieved when they seemed to potentially meet the inclusion criteria. The inclusion criteria were then applied independently by both the authors to retrieved articles. Any differences were referred to a senior author for final analysis. There were no restrictions regarding the type of study or the characteristics of patients. The parameters that were assessed and analyzed include demographics, time of detection, clinical presentation, mode of diagnosis, nature of intervention, site of stone, surgical findings, procedure performed, complete stone clearance, sequelae and follow-up. Articles with insufficient data (on the site of residual gallbladder stones, mode of diagnosis), unclear methodology, published before 1993 and language other than English were excluded from the study.

RESULTS

A total of 83 articles published between 1993 and 2013 were found in the databases that we searched. Among these, 18 were selected for the study on the basis of our inclusion and exclusion criteria. After analyzing the bibiliographical references of these articles, we found some other articles that had been published in the same period. Out of these, four new articles were selected and included in our study. Therefore, a total of 22 published articles were used for the present study. Among these articles, 13 had been published as case reports and 9 as case series (observational studies). There were no randomized studies available in the literature on the subject.

Patient Demographics

The patient demographics are stated in the accompanying table [].

Table 1

Patient demographics, clinical findings and nature of intervention

Clinical Presentation

The most common presentations were abdominal pain, fever and jaundice []. Some of the rarer clinical presentations included pseudocysts, vomiting, chills, liver abscess and pancreatitis.

Chowbey et al. reported a mean time of detection of 4.1 years (range 6/12-12 years). Walsh et al. reported that the mean time interval between cholecystectomy and the diagnosis of retained calculi in a gallbladder/cystic duct remnant was 9.5 years (range 14 months to 20 years). Palanivelu et al. reported a mean time of detection of 8.3 months (range 6-10.7 months).

Walsh et al. reported that patients were referred to their institute with obscure persistent symptoms post-cholecystectomy. Tantia et al. in their series reported that all the patients were symptomatic for more than 3 months prior to revision cholecystectomy. Daly et al. in their case report mentioned recurrent biliary pain and obstructive jaundice as presenting symptoms in a patient 6 months after undergoing laparoscopic cholecystectomy. Also, two more patients presented with three episodes of typical biliary colic and cholangitis 8 months and 9 months after surgery respectively. Sepe et al. reported abdominal pain as a presenting symptom in all patients. In the case series by Palanivelu et al., the presenting symptoms were jaundice in 3 patients, abdominal pain in 7 patients, cholangitis (with fever, jaundice and pain) in 2 patients, pruritis associated with jaundice in 1 patient and aymptomatic in 2 patients. Chowbey et al. reported pain in the right hypochondrium (17 patients), recurrent biliary colics (9 patients) and jaundice (9 patients) as the most common presenting symptoms. Parmar et al. reported abdominal pain in 36 patients, persistent dyspepsia as the commonest presenting symptoms.

Mode of Diagnosis

In most series, the primary diagnosis was established by ultrasound/computed tomography (CT) scan. Subsequent localization of the calculi and delineation of the biliary tract was performed by magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP). In a few series the diagnosis was established by endoscopic ultrasound (EUS), laparoscopic ultrasound, intraoperative cholangioraphy and percutaneous transhepatic cholangiography.

Chowbey et al. in their series reported that the residual gallstones were diagnosed on abdominal ultrasound in 17 patients (includes 5 patients with primarycholecystostomy). The ultrasound reported 8 patients with a remnant gallbladder containing calculi. All other ultrasound reports mentioned an echogenic focus in the gallbladder fossa. The remaining 9 patients (7 patients post-LC and 2 patients post-open cholecystectomy) were diagnosed on EUS (2 patients), MRCP (4 patients) and ERCP (3 patients) respectively. In all 9 patients, a stone was reported in the residual cystic duct stump. Seventeen patients (65.3%) were subjected to a pre-operative ERCP.

Diagnosis was established by abdominal ultrasound, MRCP in the study by Parmar et al. Walsh et al. reported that all their patients received some form of biliary imaging for diagnosis: Six patients underwent ERC, one patient underwent MRCP. ERC correctly diagnosed the presence of a retained stone in the cystic duct or retained gallbladder in 4 patients. Biliary imaging was non-diagnostic in the remaining 3 patients. Daly et al. reported ERCP as the diagnostic modality in one patient which showed a dilated cystic duct (6 mm) with a stone present at the junction of the cystic duct with the common bile duct (CBD). In two more patients, ERCP conformed the diagnosis with a long cystic duct with a remnant of Hartmann’s pouch and a filling defect inside in one patient and a stone in the CBD with 2 cm segment of residual gall bladder with dilated cystic duct in the other patient. Sepe et al. reported that all patients received biliary imaging in the form of MRCP, CT scan or ERCP. Palanivelu et al. reported that ultrasonography identified cystic duct remnant in 9 patients and MRCP identified calculus in all patients. Mahmud et al. reported that the ultrasound scan of the biliary tree was performed to establish the diagnosis.

Nature of Intervention

Nature of the intervention for residual gallstones that has been described in the literature includes Laparoscopic surgery, endoscopic techniques and open surgery. Laparoscopic surgery included remnant cystic duct stump excision and completion cholecystectomy along with drainage of the pseudocyst. Endoscopic management included endoscopic stone extraction, endoscopic pappilotomy, extracorporeal shock wave lithotripsy (ESWL), laser lithotripsy and cholangioscope guided lithotripsy

Tantia et al. in their series of 7 patients reported that 2 patients had direct radiological evidence of CBD calculi along with a large stump without any calculus. ERC and stone extraction were attempted in both these patients who failed due to large calculus in CBD in one and multiple stones in other. These two patients underwent laparoscopic completion cholecystectomy along with laparoscopic CBD exploration. In the first patient CBD clearance was confirmed with intraoperative choledochoscopy and primary closure of CBD was performed with antegrade stenting. In the second patient after clearing the CBD, laparoscopic choledochoduodenostomy was performed due to large stone load. The remaining five patients underwent laparoscopic completion cholecystectomy.

Chowbey et al. in their case series on laparoscopic management of residual gallstones reported that 26 patients underwent a revision or laparoscopic completion cholecystectomy for residual gallstones disease. Out of these, laparoscopic excision of gallbladder remnant was performed in three patients, and excision of cystic duct stump with stone was performed in 18 patients. A formal laparoscopic cholecystectomy was performed in 5 patients who had previously undergone cholecystostomy and cholecystolithotomy. Parmar et al. reported that all 40 patients were managed by laparoscopic excision of gallbladder remnant, except for two patients who required conversion to open surgery. These two patients required conversion due to severe dense adhesions.

Walsh et al. reported in their series that the management was accomplished partly on the basis of how the definitive diagnosis had been obtained. Three patients who were diagnosed only at the time of surgery underwent resection of gallbladder remnant (one patient) and excision of retained cystic duct with calculi (two patients). Four patients had an ERC that accurately diagnosed a retained remnant or calculi. Two of these patients were treated surgically, one via completion laparoscopic cholecystectomy and the other via open excision of a retained cystic duct with impacted stones. Two patients underwent definitive endoscopic therapy: Both required fragmentation of cystic duct calculi which was achieved with ESWL in one and Holmium laser application in the other. The stone fragments were then swept from the cystic and common ducts with a balloon catheter.

Daly et al. in their case report of 3 patients reported that in one patient ERCP showed a dilated cystic duct (6 mm) with a stone present at the junction of the cystic duct with the CBD but the CBD was normal. The stone was unable to be retrieved endoscopically after a sphincterotomy was performed. A subsequent ERCP confirmed that the stone had passed. The second patient underwent ERCP. At ERCP, a long cystic duct was demonstrated with a remnant of Hartmann’s pouch and a filling defect inside. A laparoscopic exploration was performed, and the gallbladder stump resected. The third patient underwent the sphincterotomy after the ERCP demonstrated a stone in CBD and 2 cm segment for residual gallbladder with dilated cystic duct. The stone was retrieved at sphincterotomy. Completion cholangiogram revealed no other stones.

Sepe et al. in their series on single operator cholangioscopy for extraction of cystic duct stones reported that 13 patients underwent 17 single operator cholangioscopy (Spyglass Direct visualization system, Boston Scientific, Natick, Mass, USA) for extraction of cystic duct stones. A single stone was present in the cystic duct in 9/13 patients, and at least 3 stones were present in 4/13 patients. In 7 patients, stones were noted to be in the distal cystic duct. Three patients had multiple stones in the remnant cystic duct. In 3 patients, the exact location of the stones could not be ascertained despite the review of cholangiogram and endoscopy images. The decision was made to go directly to a spyglass procedure in 3 patients rather than attempt a traditional approach given the large and multiple cystic duct stones. Twelve of 17 procedures were completed with patients under monitored anesthesia care, and 5/17 were performed under general anesthesia. Complete cystic duct clearance on the first attempt was achieved in 7/13 patients. One patient had partial extraction on the first attempt and had a repeat cholangioscopy 6 weeks later achieving complete cystic duct clearance. One patient had successful extraction of 3 cystic duct stones, but one stone dislodged into the CBD and could not be removed. A stent was placed, and ERCP was performed 6 weeks later with successful bile duct clearance. One patient had failed extraction and underwent a repeat spyglass procedure 3 months later in which the cystic duct was noted to be clear. Thus, complete clearance was achieved in 10 of 13 patients.

Palanivelu et al. reported that all 15 patients were successfully managed by laparoscopic excision of the remnant gallbladder/cystic duct. These patients had undergone laparoscopic subtotal cholecystectomy at the same center. The remnant cystic duct could be completely excised in 11 patients and CBD closed with intracorporeal suturing using 3.0 Vicryl. In the other 4 patients, closure after remnant excision could not be achieved and a T tube was inserted into the CBD via the cystic duct opening.

Site of Residual Gallbladder Stone

The residual gallbladder stones were retrieved from the gallbladder remnant in 64 patients, remnant cystic duct in 46 patients and in 3 patients from the CBD.

Follow-up

The mean follow-up from reported literature was 1.44 years (range 4 months-3. 2 years). One patient developed obstructive jaundice. Two patients had pancreatitis and 2 patients reported bilious drainage in the post-operative period. A minor CBD injury and port site infection were reported in one patient each.

DISCUSSION

Persistence of symptoms after cholecystectomy may be due to retained stones or regeneration of stones in the remnant gallbladder.[18,19] This usually takes the form of right upper quadrant abdominal pain and dyspepsia, with or without jaundice. The causes of post-cholecystectomy syndrome are often non-biliary like peptic ulcer, gastroesophageal reflux, pancreatic disorders, liver diseases, irritable bowel and coronary artery disease.[19] However, in some of these patients the cause may be biliary such as choledocholithiasis, traumatic biliary stricture, sphincter of Oddi dysfunction or cystic duct/gallbladder remnant.[20,21] Patients with symptoms suggestive of gallstone disease such as biliary colic and obstructive jaundice justify a detailed evaluation to rule out any retained stone. The incidence of post-cholecystectomy syndrome has been reported to be as high as 40%, and the onset of symptoms may range from 2 days to 25 years.[18,22,23,24] There may also be gender-specific risk factors for developing symptoms after cholecystectomy. Bodvall and Overgaard found that the incidence of recurrent symptoms among female patients was 43%, compared to 28% among male patients.[25]

Several reports have proposed that a cystic duct remnant >1 cm in length after cholecystectomy may be responsible, at least in part, for post-cholecystectomy syndrome,[26,27] other authors refute this.[4,25] Residual gallstones are more often reported in cystic duct remnants. The possible etiology of such an occurrence is often a failure to define the cystic duct, CBD junction. This is more likely to occur in the presence of acute local inflammation or fibrosis. It may be prudent to dissect the cystic duct up to the common duct defining their junction in selected patients. Patients at increased risk of harboring stones in the cystic duct are patients with a history of biliary colics, pancreatitis, obstructive jaundice and those having undergone therapeutic ERCP prior to clipping and dividing the cystic duct. Stones in the cystic duct may be evident on visualization or may also be palpated with the dissector. Adhesions around the cystic duct may be another indicator of an impacted stone within it. In these circumstances, dissection should continue proximal to the stone towards junction of the cystic duct and CBD. With increasing experience, it is almost always possible to apply clips on the cystic duct proximal to the stone. No attempt should be made to ‘milk’ the stone distally, as such a maneuver may fragment the stone that may pass into the common duct and lead to biliary colic in the post-operative period.

Moody[19] included gallbladder remnant among the main causes of post-cholecystectomy syndromes; he cited Bodvall’s previous experience concerning 26 cases of gallbladder remnant as a cause of post-cholecystectomy syndrome observed in a total of 103 cases operated on, equal to an incidence of 25%.[25] Stone recurrence in a gallbladder remnant after cholecystectomy, either laparotomic or laparoscopic, may arise alternatively from three different conditions: Inadvertent incomplete gallbladder removal, incorrectly performed subtotal intentional cholecystectomy (fundectomy alone), or ultimately the existence of a duplicated or even triplicated gallbladder inadvertently missed at the intervention (or probably voluntarily missed because seemingly healthy). Incomplete gallbladder removal during cholecystectomy may be both voluntary and inadvertent. Kuster and Domagk recommend a temporary laparoscopic cholecystostomy followed by delayed laparoscopic cholecystectomy as an alternative to conversion to open cholecystectomy in acute cholecystitis.[28] Similar recommendations have been duplicated by other authors wherein a tube cholecystostomy has been suggested to be a good salvage procedure in select patients with acute cholecystitis or a poor general condition.[29,30,31] Subtotal cholecystectomy has been recommended as a safe and viable option in patients where anatomical distortion at Calot’s triangle precludes a safe dissection.[31,32,33,34,35] Conversion rate to open surgery is higher for patients with acute cholecystitis than in those without acute cholecystitis. Laparoscopic subtotal cholecystectomy has been suggested as an alternative to decrease this conversion rate.[35]

Recent progress in radiological imaging has greatly improved diagnostic accuracy in detecting the causes of persistence of symptoms in post-cholecystectomy patients.[1,36] Ultrasound, CT scan, ERCP, and MRCP are all effectively used to achieve a diagnosis of gallbladder remnant with or without stones in patients complaining of symptoms consistent with post-cholecystectomy syndrome. Nevertheless, diagnosis of residual gallbladder with gallstones remains difficult. An EUS is indicated in the presence of a high index of clinical suspicion with a negative abdominal ultrasound. EUS has proven its feasibility in diagnosing liver and biliary pathologies with a high sensitivity (96.2%) and specificity (88.9%) and has also been shown to be cost effective in avoiding a number of ERCPs.[37,38,39] ERCP is popular as a diagnostic and therapeutic tool in managing extrahepatic biliary pathology. However, it is an invasive investigation and associated with a specific procedure related complications.[40] The main advantage of MRCP is its non-invasiveness, absence of sedation and avoidance of radiation exposure. Its sensitivity and specificity are similar to EUS.[39]

Treatment options depend on the suspected etiology. Once the patient has been diagnosed with residual stone, surgical excision should be undertaken to avoid potentially life-threatening complications, such as carcinoma, recurrent cholangitis, mucocele, recurrent cholelithiasis with gross dilatation of remnant, and Mirizzi syndrome.[23,41]

The first laparoscopic completion cholecystectomy was reported by Gurel et al. in 1995.[25] Traditionally, the open technique was considered as the procedure of choice for tackling these residual stones. Later, the laparoscopic approach became popular, though only attempted in advanced centres. After incomplete cholecystectomy, the cystic duct stump and Calot’s triangle is usually embedded in inflamed scar tissue, so it was thought that the surgical risk was too high to reoperate laparoscopically in these cases. As in other surgical disciplines, minimally invasive surgery has revolutionised the management protocol of these patients, subject to availability of expertise. Many experts have successfully excised the cystic duct remnant laparoscopically, thus, leading to full recovery of the patient without significant post-operative morbidity. It has now been suggested that it is safe and feasible to remove the gallbladder or gallbladder remnants in such patients laparoscopically.[42] Despite some previously reported contrary opinions, the laparoscopic approach to reoperations on the biliary tract appears to be a minimally invasive, safe, feasible, and effective procedure when done by expert laparoscopic surgeons.[43]

Case reports of cystic duct calculi after cholecystectomy show mixed results about interventions using ERCP alone.[9,23,44,9] During the last two decades, cases have been reported in which cystic duct remnant stones were treated endoscopically, either percutaneously after surgical cholecystostomy or via a retrograde transpapillary approach.[45,46] Beyer et al. noted that it was easy to extract multiple stones from the cystic duct remnant in their patient, but Kodali and Petersen encountered marked problems in removing calculi from two patients with post-cholecystectomy Mirizzi syndrome. Non-surgical option like ESWL is also reported.[47] With evolving experience and the development of ancillary methods, such as ESWL, EHL (Electrohydraulic lithotripsy), and laser lithotripsy, it has become possible to treat patients with Mirizzi syndrome by using interventional endoscopic methods. ESWL, combined with appropriate therapeutic endoscopic interventions, is safe and effective for the treatment of cystic duct remnant stones and Mirizzi syndrome, especially when it is desirable to avoid surgical therapy

Footnotes

Source of Support: Nil

Conflict of Interest: None declared.

REFERENCES

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Diagnosing Digestive Problems After Gallbladder Surgery

You followed the pre-op instructions to a T. The procedure went swimmingly. And while the pain has disappeared with your gallbladder, now you’re dealing with some less than ideal side effects.

We’ve gathered a list of the potential side effects that you may experience following a laparoscopic or open gallbladder removal procedure, as well as steps for treating these unfortunate side effects.

Let’s check it out.

Temporary/Chronic Diarrhea: Patients can sometimes experience temporary diarrhea following a gallbladder removal surgery because the gallbladder is no longer there to regulate the flow of bile, which can result in a smaller, more constant flow of bile into your small intestine. While each person adapts differently to surgery and it may take a variable amount of time for different people, you should not be suffering from distressing symptoms, especially due to postcholecystectomy diarrhea. If your symptoms persist for more than a few days, please contact your gastroenterologist. Chronic diarrhea can be managed with a low-fat diet as well as medication for binding excess acids in the digestive system. It is amazing (and sad) to see how many patients come years after their gallbladder surgery, having been troubled by chronic diarrhea for years, only to be fixed easily by a gastroenterologist.

Constipation: Post-surgery pain medication immediately after surgery—especially if they are opioid—may cause constipation. By consuming a diet high in fiber, you can prevent/relieve constipation. Sometimes you need other laxatives to be prescribed as well. It is best to rectify the problem ASAP, before it causes fecal impaction and abdominal pain, etc.

Retained stone: If stones traveled from your gallbladder prior to its removal, they can still cause pain, fever, nausea, vomiting, bloating, and jaundice. You may need an additional procedure to remove gallstones that are retained in your common bile duct.

If you have persistent symptoms after surgery, you need evaluation to decide if the cause of pain is something else. Retained stones in the bile duct or even new stones that may develop after surgery cause symptoms and abnormal labs that help in the right diagnosis if evaluated appropriately.

Intestinal injury: Instruments used in surgery could damage your intestines—resulting in abdominal pain, nausea, vomiting, and fever. It’s vital to seek immediate medical attention if you experiencing any of these symptoms.

If you are experiencing these or any other symptoms that you believe may be linked to your gallbladder removal, please contact a gastroenterologist immediately. The digestive specialists at GI Alliance are here to guide you on your path to digestive health.

Click Here to Find a Location Near You

Gall Bladder Post-Op – Division of Gastrointestinal Surgery

Returning to Normal

Returning to normal may take a few days or weeks, depending on your body’s healing power. People can lead a normal, healthy life without the gallbladder.

Pain

There is usually minimal pain associated with this operation. The abdomen will be sore as well as the small incision sites, and some patients have shoulder pain for the first day or two. The shoulder pain is caused by gas left in your abdomen during the operation. It will disappear on its own. When you are discharged home you will be given a pain medication to take if necessary. The first few days you may want to take the pain medication so that you will be more comfortable. As you become more active the amount of pain medication needed should decrease quickly. Some patients find that after the initial recovery period is over that medications such as Tylenol or Ibuprofen work well. As with any type of surgery, it is reasonable to expect some amount of pain. This varies with individual patients and depends on your body’s response to pain medication.

Diet

Most patients are concerned about what they can eat after the cholecystectomy. You are permitted to eat what you would like. Most patients find that a bland diet of such foods as: toast, rice, bananas, soups, pasta etc. are the easiest to digest initially. After the initial recovery period most patients can tolerate a variety of foods without difficulty. It is not uncommon for it to take a few days for your normal appetite to return following surgery.

Wound Care

There will be four small wounds on your abdomen after the operation, three under your right ribs and one at the belly button. These wounds are usually closed with dissolvable stitches. These areas need to be kept clean. You may shower and bathe when the bandages are removed. You should look at the wounds every day and call the GI Surgery Nurse at (919) 966-8436 if there is redness or any bleeding from these areas. Sometimes you will notice bruising around the wounds, this is normal.

Driving a Car

As long as you are not taking pain medicine stronger than Tylenol or Ibuprofen and when you feel as though your reaction time is normal, you may begin driving. Do not drive if you are taking any kind of pain medicine or medicine that impairs your judgment. Most patients wait until they no longer feel their abdomen is sore.

Work

Most patients feel strong enough to return to work in a 1 to 2 weeks following the operation. Some patients may return sooner if they do desk work. If you do work that requires you to lift or bend then you may need to be placed on restricted work duty until you have your post-operative appointment. If you need a letter or work excuse to be sent to your employer, please let your surgeon or the GI Surgery nurse know.

Bowel Habits

Normal bowel habits may be altered by several factors regarding surgery. Constipation is common. Anesthesia, decreased activity, and narcotic pain medications are factors that may cause constipation. You should be aware to increase fiber in your diet as soon as possible and to increases your fluid intake. If necessary you may take a mild laxative. Infrequently patients develop loose stools or diarrhea after a cholecystectomy. This may go away within days or may last for several weeks. This is easily treated with medication.

Activity and Exercise

Patients feel like doing activities within a few days of having their operation. You should not lift anything heavier than 8 to 10 pounds (a gallon of milk) for 2 weeks. After this period of time you can begin lifting heavier objects being aware that if your abdomen hurts you should not be lifting. Walk as much as is comfortable for you, moderate exercise helps improve circulation. You may shower the day after the operation. You may resume sexual relations when it feels comfortable for you.

Potential Problems

As with any operation there is a possibility of complications. Included in these complications are bile leaks and/or bile duct injuries. Although these can be serious complications, they occur very rarely. Your surgeon will discuss these with you.

Some potential short-term complications that may arise shortly after the operation are:

Loose bowel movements – may occur because bile is not being concentrated in the gallbladder, it is spilled directly into the small intestine from the liver. It often takes a few days to a few weeks for your body to adjust. If the symptoms become severe, you should notify the surgeon or the GI Surgery nurse.

• Infection – infection can occur with any operation. Every step is taken to ensure that this does not take place.
• Wound infection – these infections are usually superficial or on the surface, and can be treated by draining the infected site.
• A long term complication that may arise months or years after your operation is a:   Hernia – A hernia is a protrusion of tissue through a weak spot in your incision. Hernias are not common after laparoscopic surgery, but do occur. An operation is necessary to repair the hernia.

Conclusion

Most patients feel much better following this operation. The gallbladder is an important organ, but not essential for life. The surgeons here at UNC Hospitals have been performing this procedure since its inception. They have experience in all aspects of care regarding patients with gallstones. We encourage you to speak to patients who have had this operation. We are glad to give you the names of previous patients who are willing to talk to potential patients.

This information is being provided to help patients understand laparoscopic cholecystectomy. You should talk with your physician about any medical advice dealing with your medical diagnosis.

Warning Signs You May Need Your Gallbladder Removed

The human body contains a few organs that may leave you scratching your head as to their purpose.  Why do we have an appendix or wisdom teeth for instance?  Science refers to these as vestigial organs, meaning that while they were once useful, they serve no purpose to humans today.  Then, there are organs such as the gallbladder that are a step above vestigial organs in their function but which the body can still function just fine without.

What is the Purpose of the Gallbladder?

The gallbladder’s role is in digestion, and while it does serve a purpose, it isn’t essential.  This small, pear-shaped organ is located just below the liver.  It stores small amounts of bile that are released into the small intestine after eating to aid in the digestion of fats.  However, it can also become the source of painful and troublesome symptoms should it become inflamed or develop gallstones.

Symptoms of a Gallbladder Problem

The primary source of problems within the gallbladder, including inflammation, stem from the development of gallstones.  These hard deposits of digestive fluid can occur in the gallbladder itself or in the bile duct, and they can range in size from as tiny as a grain of sand to as big as a golf ball.  Some patients may only develop a single gallstone, while others will have several.  However, it is not the presence of gallstones but the complications they cause that may necessitate surgery.  When these deposits develop and cause a blockage in the bile duct, the bile is unable to circulate out of the liver as normal, building up and resulting in painful inflammation in a condition known as cholecystitis.  The symptoms associated with the condition include:

• Sudden and severe pain at the upper right or center abdomen
• Tenderness of the abdomen
• Pain after eating
• Fever
• Nausea and vomiting

If left untreated, the complications could lead to an infection or even cause the gallbladder to tear or burst.

What Can You Expect from Gallbladder Surgery?

If gallstones have been identified as the source of your symptoms, treatment options could include dietary changes and medications to dissolve existing gallstones or prevent the development of new ones.  However, surgical removal of the gallbladder (cholecystectomy) is the most common treatment.  Fortunately, the procedure is common and has minimal risk of complications.  Most frequently, it is performed on an outpatient basis using minimally invasive laparoscopic techniques. 

After the procedure, patients are generally able to go home the same day, barring complications.  Full recovery may take up to a week, and most can return to normal activity within a few days.  While digestive complications following the surgery are rare, some patients experience side effects such as loose stools that tend to resolve over time.

If you have been experiencing symptoms associated with gallstones, do not put off a visit to your physician.  It is unlikely that the condition will resolve on its own.  In fact, it may worsen and lead to more severe complications down the line.  Gallbladder removal is not only simple, but it is also highly effective at alleviating symptoms once and for all, allowing patients to once again eat and function without discomfort. 

The team at Lane Surgery Group perform cholecystectomies regularly and with great results.  Click below to learn more about our team and facility.

Gallbladder Removal: Laparoscopic Method – familydoctor.org

The gallbladder is a small, pear-shaped organ just under your liver. It stores bile, the digestive fluid the liver makes to digest fat. Sometimes the gallbladder gets inflamed. This happens when the flow of bile is blocked. This can be caused by gallstones (hard deposits that form inside your gallbladder), injury, or other conditions. When this happens, you may experience pain and other symptoms. Your doctor may want to remove your gallbladder. Fortunately, we don’t need our gallbladders to live. And removal usually doesn’t cause complications.

It is important to note that not all people who have gallstones require surgery to remove their gallbladder. Your doctor will help decide which course of action is best for you and your symptoms.

Path to improved health

If you have gallbladder pain and other symptoms, you may need surgery to remove your gallbladder. The surgery is called a cholecystectomy. You’ll be given anesthesia, so you’ll be asleep and not feel any pain during the surgery.

During traditional surgery, the gallbladder is removed through a 5- to 8-inch-long incision (cut) in your abdomen. This is called an open cholecystectomy.

The more common way to remove the gallbladder is called a laparoscopic cholecystectomy. During this surgery, 3 to 4 small incisions are made in your abdomen. Then instruments are inserted through the cuts. The surgeon uses the instruments to look at the gallbladder and remove it.

One of the instruments used is called a laparoscope. This is a small, thin tube with a camera and light on the tip. The camera is used to see the inside your body. The camera shows your gallbladder on a TV screen. This allows the doctor to see the gallbladder while he or she removes it. Your doctor will do this using tools inserted in the other cuts. Your gallbladder is then taken out through one of the incisions.

After the gallbladder is removed, your doctor will clamp off all the bile ducts. He or she will close the incisions with stitches, staples, or glue. The procedure takes 1 to 2 hours. Most people go home the same day or the day after the surgery.

What are the benefits of this type of surgery?

Laparoscopic gallbladder removal has many advantages. Unlike traditional surgery, laparoscopic surgery can be done without cutting the muscles of your abdomen. This may allow you to:

• Have less pain after surgery.
• Have a shorter hospital stay.
• Have a shorter recovery time.
• Return to work more quickly.
• Have much less noticeable scars than with a traditional cholecystectomy.

Who shouldn’t have this type of surgery?

Laparoscopic surgery isn’t the best choice for everyone. An open surgery may be better if you:

• Had surgery around your gallbladder before.
• Tend to bleed a lot.
• Have any problem that would make it hard for your doctor to see your gallbladder.

Your doctor will decide which type of surgery is appropriate for you.

Things to consider

As with any surgery, there could be complications. These are rare but could include:

• bleeding
• infection
• injury (to the tube that carries bile from your gallbladder to your stomach)
• bile leakage

In addition, the intestines, liver, or major blood vessels may be injured when the instruments are inserted into the abdomen. Remember, these complications are rare. But if you’re experiencing unusual pain after gallbladder surgery, call your doctor right away.

Questions to ask your doctor

• Do I need to have my gallbladder removed?
• Which type of surgery is best for me?
• What are the risks of laparoscopic surgery?
• How long will I be in the hospital?
• How long will it take me to recover?
• What are signs of complications?

Resources

National Institutes of Health, MedlinePlus: Gallbladder removal—laparoscopic

Copyright © American Academy of Family Physicians

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.

Lifestyle after removal of the gallbladder / Blog / Clinic EXPERT

Frequently asked questions

Do disability after removal of the gallbladder?

According to the criteria established by the medical community, the absence of a gallbladder itself is not an indication for assigning a disability, because it does not interfere with work and mental activity. In the event that the patient’s work is associated with heavy physical labor or high mental and emotional stress, he may be recommended to facilitate working conditions.

Disability after removal of cholecystectomy can be attributed if complications occur during or after surgery.

To obtain a disability group, you must apply for a medical and social examination (ITU).

Can the liver hurt after removal of the gallbladder?

The liver itself does not hurt – there are no nerve endings responsible for the feeling of pain in it. If you are experiencing pain and discomfort in the right hypochondrium, this is probably the aftermath of gallbladder surgery, which should go away within a week.

If the symptoms persist, this may indicate the development of postcholecystectomy syndrome (PCES), with which it is recommended to consult a gastroenterologist.

Is it ok to have sex?

Sexual activity, like sports, is characterized by a wide range of possible physical and physiological stresses. After successful completion of postoperative recovery, patients can return to normal sex life. However, it should be remembered that certain positions during intercourse, involving lifting a partner or squeezing the abdominal area, should be used carefully and within reasonable limits.

Is it possible to carry a pregnancy after removing the gallbladder?

Planning a pregnancy should not be earlier than 3-6 months after a successful operation. During this period, the body will regain its strength and it will become clear whether there are negative consequences after the intervention.

In any case, pregnancy, childbirth, hormonal changes are risk factors for the formation of new stones. During and after gestation, it is necessary to pay special attention to the nutrition of the expectant mother, it is advisable to be under the supervision of a gastroenterologist and a nutritionist, to do preventive ultrasound of the bile ducts.

Is it ok to lift weights?

This primarily depends on the type of operation performed. With less invasive laparoscopic gallbladder removal, the restrictions on weight lifting in the postoperative period are less significant: do not lift weights above 9-10 kg in the first 4-6 weeks. For open surgery to remove the gallbladder, the weight limit is 5-6 kg.

After the end of the recovery period, you can try to lift more significant weights, but you need to listen to your well-being.If you feel unpleasant sensations in the abdomen, then you should stop lifting weights and consult a doctor.

Is a cold immediately after surgery dangerous?

A common cold, acute respiratory infections or acute respiratory viral infections can affect any person, and the patient’s body after removal of the gallbladder is especially vulnerable, since his immunity is reduced in the first weeks after surgery and general anesthesia. That is why, for the prevention of colds, it is important to avoid hypothermia, drafts and follow the regimen prescribed by the doctor.

The danger is that some people may develop postoperative pneumonia after surgery. The symptoms of this disease in the initial stages resemble the common cold. If symptoms similar to a cold occur after the operation, but then the temperature rises significantly (above 38 ° C), you should immediately consult your doctor.

The same should be done in cases where the temperature of 37.1-38 ° C lasts for several days or colds symptoms gradually worsen.

Is it possible to take hot baths, go to the bathhouse and when?

An increase in body temperature in a hot bath or steam bath increases blood flow and inflammation, if any. You can wash in warm and hot water 3-4 weeks after removing the stitches – with care, not being exposed to high temperatures for longer than necessary.

You need to be careful:

• to warm up only until the first sweat
• to control your well-being
• Prefer a wet bath to a dry sauna.

Can I smoke and drink alcohol after removing the gallbladder?

Try to give up cigarettes, or at least reduce their number as much as possible. Nicotine is one of the factors in the formation of new stones in the bile ducts. In addition, immunity is weakened after any surgery, and the risk of complications becomes higher. To avoid postoperative pneumonia, smokers are advised to stop using nicotine products, including gum and nicotine patches, at least two weeks before surgery.

The same applies to the consumption of alcoholic beverages. Drinking alcohol during the postoperative recovery period can lead to an increased risk of complications such as diarrhea, increased liver enzymes in the blood, and slower recovery.

How does the lifestyle change after removal of the gallbladder?

The lifestyle does not change dramatically after the recovery period, therefore after 1 month, as well as after 2, 3, 4, 5, 6 months, after a year or two, the main thing is to adhere to the general recommendations.

Major changes after cholecystectomy focus on diet and exercise . They should be gentle and introduced gradually and carefully. In case of alarming manifestations, you should immediately consult your doctor. It is a good idea to keep a diary that can be used to track the body’s response to specific innovations.

It is important not to spur the body, but gradually and carefully introduce new elements into your routine that will heal and strengthen the body in new realities. It is useful to actively practice the most gentle and harmonious sports that improve metabolism and reduce stress levels (yoga, Nordic walking, swimming). The digestive system is sensitive to stress levels, so it is important to avoid extreme emotional stress, master various methods of protection against overwork (autogenous training, breathing techniques) or seek help from a psychotherapist.

Gastroenterology: Postcholecystectomy syndrome – diagnosis and treatment in St. Petersburg, price

Cholelithiasis (GSD) is one of the most common diseases of modern humans.It ranks third after cardiovascular disease and diabetes. In developed countries, gallstone disease occurs in 10-15% of the adult population.

On the territory of Russia, about 1 million people turn to medical institutions for cholelithiasis every year. The number of cholecystectomies performed annually in Russia as a whole ranks second, second only to the number of appendectomies. In Moscow and other large cities, about 7,000 operations are performed per 100,000 population per year.

Most of these operations in recent years have been performed using minimally invasive technologies (small access surgery, endovideosurgery, transluminal surgery). Since the number of operations for gallstones is constantly growing, the number of patients with various postoperative problems is also increasing. According to different authors, 1-2 out of every 10 operated patients after performing cholecystectomy continue to experience discomfort from the gastrointestinal tract, pain, digestive disorders, and repeated pain attacks.Gastroenterologists refer to these symptoms as Postcholecystectomy Syndrome (PCES). The recurrence of pain in half of the cases occurs within the first year after the operation, but it can also appear in the long term.

Terminology and classification

The term PCES was introduced in the 1930s by American surgeons and is still used today. It unites a large group of pathological conditions in the hepatopancreatoduodenal zone that existed before cholecystectomy, accompanied cholecystitis, complicated it or emerged after surgery.In many respects, this association is due to the fact that when a patient returns with complaints after undergoing cholecystectomy, it is rarely possible to correctly diagnose without a multicomponent, comprehensive examination. At the same time, the generalizing term PCES is used as a temporary diagnosis in the process of examining a patient in accordance with a differential diagnostic algorithm. In the future, in most cases, it is possible to find out the cause of the patient’s complaints and a more general term gives way to a specific diagnosis.

All pathological conditions that are observed in patients after removal of the gallbladder are divided into two main groups depending on the causes of their occurrence:

• functional disorders,

90,051 organic lesions.

In turn, organic includes:

• lesions of the biliary tract;
• lesions of the gastrointestinal tract, among which diseases of the liver, pancreas and 12 duodenum should be distinguished;
• diseases and causes not associated with the gastrointestinal tract.

But PCES itself, that is, a condition that arose after surgery to remove the gallbladder, is extremely rare. It is caused by an adaptive restructuring of the biliary system in response to the exclusion of the gallbladder from it – an elastic reservoir in which bile is collected and concentrated. In other cases, there are diseases that simulate PCES.

Modern gastroenterological studies indicate that in half of the patients, functional disorders of digestion are the cause of complaints.Organic disorders, which are found in a third of those who apply, are really the result of the performed operation only in 1.5% of cases, and only 0.5% of patients with an established diagnosis of PCES require repeated surgery. If a diagnosis of PCES is established, questions inevitably arise related to legal and insurance liability for violations that have arisen after the provision of medical assistance. Therefore, among the variety of pathological conditions that pass under the brand name of PCES, it is proposed to distinguish two main groups, depending on the nature of the causal relationship with the previous cholecystectomy:

• diseases not related to the transferred operation – as a rule, these are diagnostic errors;
• diseases that are a direct consequence of surgical intervention, that is, an operational error.

Diagnostic errors include:

• Concomitant diseases or diseases not identified before the operation are similar in their clinical picture to the manifestations of cholelithiasis. These are situations when a diagnostic error occurred and, although as a result of the operation, the gallbladder filled with calculi was removed, the true source of pain was not eliminated.
• Diseases of other organs located in the same area, which are in no way associated with surgery, but according to the complaints that have arisen, they resemble a relapse of gallstone disease and after surgery disturb the patient.

Operational errors include

• Residual choledocholithiasis (stones left in the bile ducts).
• Papillostenosis (narrowing of the area where the bile ducts enter the intestine).
• Tumors of the bile ducts and the head of the pancreas.
• Damage to the bile ducts during surgery.

Most of these errors are caused by incomplete preoperative examination and subsequent discrepancy between the volume of surgical intervention and the nature and stage of the main pathological process.This, first of all, manifests itself in the treatment of complicated forms of gallstone disease, when only standard cholecystectomy is performed instead of more advanced options for intervention. In this case, there is an error according to the formula “incomplete diagnosis – insufficient volume of surgery”.

And, finally, the most dangerous is the group of direct iatrogenic surgical complications. The symptomatology of PCES in patients with various abdominal disorders appears at different periods after cholecystectomy, and sometimes is a continuation of the same disorders that were before the operation and did not stop after it.The variety of symptoms and different periods of its appearance are determined by those specific reasons that underlie these disorders.

Causes of “postcholecystectomy syndrome”

1. The most common cause of PCES is stones of the bile ducts (choledocholithiasis). It is important to distinguish between true relapses of cholelithiasis, when calculi in the bile ducts are formed again after the performed cholecystectomy, and false ones, when there are residual (remaining, preserved) calculi.The vast majority of bile duct stones are stones not removed during the first surgery. “Forgotten” stones account for 4 to 12% of all cholecystectomies performed. In recent years, after the widespread introduction of laparoscopic and endoscopic technologies into practical medicine, the surgical tactics of treating patients with cholelithiasis began to change. Nowadays, choledocholithiasis is not a contraindication to laparoscopic cholecystectomy, and for this category of patients, a two-stage treatment is considered the standard approach: endoscopic papillosphincterotomy and removal of calculus from the common bile duct followed by laparoscopic cholecystectomy.A reverse sequence of stages is also possible, when a single small calculus is detected in the common bile duct, which is left for removal by the endoscopic method in the postoperative period.

2. Changes in the greater duodenal papilla (BDS), both organic and functional. It is with this that the appearance of relapses of pain after surgery, temperature or jaundice is often associated, although the gallbladder has already been removed.

The reasons are functional.The performed cholecystectomy leads to a temporary (up to 6 months) increase in the tone of the BDS sphincter in 85% of patients. This condition is most often associated with the simultaneous disappearance of the reflex influence from the gallbladder on the sphincter. Later, in the absence of pathological changes in the organs of the hepatoduodenopancreatic system, the sphincter tone is normalized, the normal passage of bile is restored.

Organic lesion of the OBD (stenosis) can be found in almost a quarter of patients operated on on the biliary tract.More often it develops as a result of traumatic injuries during the passage of stones or their arrangement in the ampoule. First, edema of the OBD appears, and with prolonged exposure and traumatization, cicatricial changes leading to its narrowing. Endoscopic papillosphincterotomy is the method of choice for the treatment of cicatricial stenosis of OBD.

In 5% of patients who underwent removal of the gallbladder, the cause of PCES is the deficiency of the OBD, leading to a violation of the obturator function and dehiscence of the mouth.It is based on dystrophic changes in the wall of the duodenum with atrophy of the mucous membrane and deformation of the valve apparatus. Free flow of the contents of the duodenum (reflux) into the bile ducts through the gaping OBD leads to cholangitis and pancreatitis. The clinical picture consists of epigastric pain and dyspeptic disorders in the form of a feeling of heaviness and bloating that occur after eating. Fibroduodenoscopy reveals a gaping OBD. More valuable information can be obtained with fluoroscopy of the stomach and duodenography: barium suspension enters the bile ducts, sometimes an overstretched ampoule of BDS is visible.

When this pathology is detected, treatment begins with the conservative elimination of inflammatory changes in the duodenum. The detection of organic causes that cause duodenostasis and duodenobiliary reflux is an indication for surgical treatment.

3. Strictures and injuries of the bile ducts. Postoperative bile duct strictures complicate 1-2% of surgical interventions performed on the biliary tract. The narrowing of the duct occurs either as a result of inflammatory changes in its wall, or is a consequence of the stone in it.But sometimes it occurs due to external reasons: as a result of their involvement in scar tissue in case of duodenal ulcer, pericholedocheal lymphadenitis or other inflammatory phenomena in this area. There is another reason leading to the narrowing of the ducts – primary sclerosing cholangitis.

The main manifestations of cicatricial obstruction of the bile ducts are jaundice, cholangitis, external biliary fistula and complaints caused by the development of secondary biliary cirrhosis and portal hypertension.
Treatment of ductal strictures can only be surgical. The choice of the method of surgical intervention mainly depends on the localization of the cicatricial stricture, its length and degree of obstruction, and the severity of inflammatory changes. The operation should provide full decompression of the biliary system, be, if possible, physiological, low-traumatic and exclude the recurrence of the disease.

4. Cholangitis is one of the most serious complications of gallstone disease. If bile is poorly excreted, it stagnates, and the pressure in the biliary tract rises. This creates conditions for the upward spread of infection. In this case, the cholecystectomy will remove only one site of infection, and the ducts will remain infected.

5. The next group of causes of PCES is the “excess stump” of the cystic duct left by the surgeon and the “residual” gallbladder. There are no specific symptoms for this variant of complications. Pain in the right hypochondrium, fever, and jaundice are also characteristic.Typically, pain relapses only when the remaining portion of the gallbladder or excess stump contains stones or clotted bile putty.

It is possible to detect such defects of the operation using ultrasound examination (ultrasound) of the abdominal organs. A more effective and detailed understanding of the problem will be given by performing MR cholangiography. Thanks to this study, it is possible to clarify the length of the excess cystic duct stump, as well as get an idea of ​​the width of the ducts.The emerging symptoms and the detection of an excess stump or residual gallbladder are an indication for reoperation and their removal, because they may contain calculi, putty masses, granulomas, neuromas, which are a source of inflammation. However, even if an excessive cystic duct stump is detected, it is necessary to conduct a thorough examination of the entire hepatopancreatoduodenal zone so as not to miss another possible cause of the existing complaints.

6. Tumors of the bile ducts as the cause of PCES make up 2.3-4.7%. They may not be detected during the first operation or appear later. They are distinguished by slow growth, not a sharp increase in pain symptoms. The most informative for the correct diagnosis is MR cholangiography and MSCT of the abdominal cavity with bolus contrast enhancement.

7. Diseases of the duodenum. Almost always, in patients with diseases of the biliary tract, pancreas and liver (in 72.5-98.5% of cases), changes in the duodenum are found in the form of edema and hyperemia of the mucous membrane, its atrophy or impaired motor function of the intestine.After elimination of the source of inflammation, these disorders can decrease, however, in most cases, without adequate treatment, chronic gastritis and duodenitis progress and create conditions for the diagnosis of PCES. Clinical manifestations are a feeling of heaviness and pain in the epigastric region, dyspeptic symptoms.

X-ray examination determines impaired peristalsis with a slowdown in the passage of barium suspension through the intestine or, conversely, accelerated evacuation with spastic peristaltic waves and duodenogastric reflux.With fibrogastroduodenoscopy, signs of pronounced gastroduodenitis are revealed.

Chronic impairment of duodenal patency (CDP) occurs in 0.45-5.7% of cases. Its clinical manifestations are masked by complaints similar to diseases of other organs. Severe pain syndrome, often of a paroxysmal nature, can be regarded as a manifestation of cholecystitis or pancreatitis. With a decompensated form of duodenostasis, an abundant one with an admixture of bile is added. With fibrogastroduodenoscopy, the mucous membrane of the stomach and duodenum is atrophic, there is duodenogastric reflux.The most informative for the detection of this form of duodenal ulcer disease is X-ray examination.

Diverticula of the duodenum are found in 2-3% of cases. Usually they are located on the inner wall of the intestine in the middle third of the descending part, where the muscular frame of the wall is weakened as a result of the vessels and ducts passing in this area. Clinical symptoms appear in the form of pain, less often vomiting. Sometimes jaundice joins with cholangitis symptoms.X-ray examination (duodenography) is of leading importance in diagnostics. With FGDS, the size of the diverticulum, the condition of the mucous membrane and the location of the OBD are specified. The treatment of this disease is surgical.

8. Chronic pancreatitis. Chronic pancreatitis in patients who have undergone cholecystectomy is quite common. It is with gallstones that there are a large number of factors that lead to damage not only to the biliary tract, but also to nearby organs.In most patients, the exocrine function of the pancreas decreases, and enzymatic insufficiency occurs.

In all cases, a technically correct cholecystectomy helps to improve the outflow of pancreatic juice and to partially restore the exocrine function of the gland. First of all, the secretion of trypsin is restored (by the 6th month), while the normalization of amylase activity indicators can be expected only after 2 years. However, with an advanced stage of fibrotic changes, chronic pancreatitis begins to manifest itself after surgery as an independent disease with exacerbations and remissions.

Usually pains are characterized as shingles, accompanied by digestive disorders, because the exocrine function of the pancreas is disturbed, and its enzymatic activity decreases. Later, in connection with fibrosis of the gland tissue, disturbances of the intrasecretory function of the insular apparatus may join. Therefore, when examining such patients, in addition to the generally accepted biochemical parameters with the determination of amylase and lipase, it is necessary to study the enzymatic activity of pancreatic juice, sugar curve and glucose tolerance test, as well as X-ray examination of the gastrointestinal tract and bile ducts.

9. Other reasons. Intestinal malabsorption, dysbiosis and colitis can simulate a relapse of pain after surgery. It is necessary to remember about hemolytic disease, proceeding with anemia, jaundice and splenomegaly, about diseases of the right half of the large intestine, right kidney and lumbosacral spine, which cause pain in 15-63% of patients, not associated with pathological changes in the biliary system.

Thus, a thorough examination of patients with PCES is necessary, including, in addition to general clinical and biochemical analyzes, ultrasound examination of the organs of the hepatopancreatoduodenal zone, fibrogastroduodenoscopy and X-ray contrast examination of the gastrointestinal tract organs, X-ray contrast studies of the biliary tract (CT, RCP or PCHG) to clarify the cause of recurrence and the choice of adequate treatment tactics.

Principles of examination of a patient with postcholecystectomy syndrome

First of all, there is a need for continuity and rational interaction of outpatient-polyclinic, general surgical and specialized links in the provision of medical care. All patients after cholecystectomy are subject to dispensary observation by a gastroenterologist both for early detection of unfavorable results and for taking preventive measures: medical nutrition, exercise, a vegetable diet with limited proteins and fats of animal origin, the use of choleretic agents that reduce the lithogenicity of bile.

Another provision is the mandatory consultation of the operating surgeon after the completion of rehabilitation. At the same time, the operating surgeon receives important information about the immediate and long-term results of surgical treatment. For the patient, this is valuable because it is in the hands of the surgeon that valuable information about the premorbid status, the features and details of the operation itself, data of auxiliary pre- and intraoperative research methods is located.

Another important condition when examining patients with PCES is the principle of searching for pathology from the most common causes to more rare ones and performing studies from simple to complex, from non-invasive, but often less informative methods to more traumatic, but giving more important information about the disease.

At the same time, against the background of the planned examination program, which includes numerous methods and takes, for obvious reasons, a long period of time, it is necessary to single out situations that require urgent referral of the patient to the hospital. Surgical alertness should be the higher, the less time has passed since the operation. This, first of all, refers to pain syndrome, accompanied by jaundice, fever, chills, nausea and vomiting, that is, when we can suspect a patient with acute cholangitis.

Examination of a patient with a presumptive diagnosis of postcholecystectomy syndrome, of course, should begin with an abdominal ultrasound. The result of the study will make it possible to exclude pronounced anatomical changes in the organs of the hepatopancreatobiliary system and to make further studies more targeted.

As for CT , its use in order to detect choledocholithiasis in the absence of pathological changes in the liver and pancreas is irrational and less informative.At the same time, it is difficult to overestimate the capabilities of CT in case of organic changes in the organs of the hepatopancreatoduodenal zone. MRI , especially performed in the MR cholangiography mode, can provide quite important information regarding the state of the biliary tract, as well as the duct system of the pancreas. And yet, despite the great possibilities of modern diagnostic methods, there is a group of patients in whom it is not possible to identify the cause of complaints after a cholecystectomy.

Treatment

Treatment of patients with PCES should be comprehensive and aimed at eliminating those functional or structural disorders of the liver, biliary tract, gastrointestinal tract and pancreas, which underlie suffering and were the reason for seeking medical attention. Lifestyle and nutrition play an essential role in the development of gallstone disease. Therefore, diet, food intake, motor regimen are the most important conditions for rehabilitation after cholecystectomy surgery.

A diet is prescribed that:

1. 1) should not provoke hepatic colic and have a harmful effect on the pancreas;

2. 2) should have a positive effect on bile secretion and on the exocrine function of the pancreas;

3. 3) helps to reduce the lithogenic properties of bile;

4. 4) improves the metabolic processes of the liver.

Drug therapy also usually includes a combination of different classes of drugs. The basis of treatment is the normalization of the passage of bile through the common hepatic, common bile ducts and pancreatic juice along the main pancreatic duct. To eliminate the relative enzymatic insufficiency that occurs in the majority of patients, to improve the digestion of fats, an adequate enzymatic accompaniment of the course of treatment is justified.

Identification of erosive and ulcerative lesions of the mucous membrane of the upper gastrointestinal tract implies antisecretory therapy, and in the diagnosis of Helicobacter pylori infection – eradication therapy.

The relief of flatulence can be achieved by prescribing antifoam agents, combined preparations, sorbents, microcrystalline cellulose preparations. Often, gallstone disease is accompanied by a violation of the intestinal biocenosis, leading to intestinal dyspepsia. In these cases, decontamination therapy is advisable. This is followed by treatment with probiotics and prebiotics.

Of course, such a comprehensive examination and treatment is most appropriate to carry out in one institution.Our clinic has all the necessary diagnostic capabilities for a full examination, treatment and rehabilitation and preventive measures.

Surgical and endoscopic treatment of bile duct stones

Relevance

Gallstones are a common problem in the population and often cause pain (biliary colic) and gallbladder infections (acute cholecystitis). Gallstones can sometimes escape from the gallbladder and enter the duct between the gallbladder and the small intestine (common bile duct).Here, they block the flow of bile from the liver and gallbladder into the small intestine and cause pain, jaundice (yellowish eyes, dark urine, and pale stools), and sometimes severe bile infections (cholangitis). About 10-18% of people who have had cholecystectomy for gallstones have common bile duct stones.

Treatment includes removal of the gallbladder and gallstones from the duct. There are several ways to do this. Surgery is performed to remove the gallbladder.In the past, it was performed through one large incision in the abdomen (open cholecystectomy). More modern methods of laparoscopic surgery are now the most common for gallbladder removal. Removal of trapped gallstones in the common bile duct can be performed either with an open incision or with a keyhole technique. An endoscope (a narrow, flexible tube equipped with a camera) is inserted through the mouth into the small intestine to allow the removal of trapped gallstones from the common bile duct.This procedure can be performed before, during, and after surgery to remove the gallbladder. This systematic review attempts to answer the question of the safest and most effective way to remove trapped gallstones (by open surgery or laparoscopic versus endoscopic removal) and whether common bile duct stones should be removed during surgery. removal of the gallbladder (as a one-stage intervention) or should be done separately before or after surgery (two-stage intervention).

Review Questions

We analyzed the results of randomized clinical trials found in the literature to assess the benefits and harms of these procedures

Quality of evidence

We found 16 studies with 1758 participants. All trials were at high risk of bias (defects in study design that could lead to overestimation of benefits or underestimation of harm). In general, the evidence is of moderate quality due to the risk of bias or bias (defects in study design), as well as random errors (insufficient number of participants in the studies), which can lead to incorrect conclusions.

Key Outcomes

Our analysis suggests that open surgery to remove gallbladder and trapped gallstones appears to be as safe as endoscopy and may be even more successful than endoscopic surgery to remove duct stones. Laparoscopic removal (“keyhole surgery”) of the gallbladder and trapped gallstones appears to be as safe and effective as the endoscopic technique.Further randomized clinical trials with a low risk of bias and random errors are needed to confirm or disprove the present results.

treatment and diagnosis of symptoms, causes in Moscow

Agarkova S.A.

15 June 2021

I express my heartfelt gratitude to Valeria Alexandrovna for her attentive, professional and patient attitude towards patients.Communication with you gives hope for recovery and the fact that in our medicine there are real specialists in their profession. Thank you all advice …

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Kurochkina Valentina Nikolaevna

4 June 2021

Inna Yurievna is a competent specialist. It is noticeable that he wants to cure the patient from the heart.Competent approach to work. I am grateful to her for making the correct diagnosis and choosing a treatment regimen.

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Ptitsyna Natalia Nikolaevna

5 March 2021

I want to express my deep gratitude to the gastroenterologist Olga Chuikova, this is a high-level specialist, when assigning me to remove a tumor in the intestine, she checked all the information on my examinations in the clinic, even for 2020 and 2019, prescribed tests, not only with regards to this situation…

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17 March 2020

I would like to express my gratitude to Elena Yurievna Lopatina for her professionalism.
Very quickly cured me of biliary slange (previously suffered with it for 4 months)

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Feyzrakhmanoa Ildar Fatehovich

15 November 2019

Many thanks to E.Yu for my salvation and competent treatment of the gastrointestinal tract, was able to quickly cure and avoid gastric resection. No operation needed! Many thanks and health to all of us!
Spouses Ildar Feyzrakhmanoa and Zuleikha Anderzhanova

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22 May 2019

Good afternoon! 21.05.2019 was consulted by a gastroenterologist, Ph.D. Lopatina Elena Yurievna. I would like to express my gratitude for such high professionalism. A very competent and talented doctor. She clearly described the treatment regimen, explained everything. All my questions were answered by …

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15 May 2019

I would like to express my gratitude to the gastroenterologist T.V. for professional work and dedication to the profession. Very attentive doctor. Professional with vast experience !!

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90,000 Cholelithiasis – what to do?

Pirogova Irina Yurievna

Deputy chief physician for organizational and methodological work, head of the center of gastroenterology and hepatology, gastroenterologist

What should a person do if such a concept as gallbladder stones suddenly and insidiously burst into his life?

Cholelithiasis is a chronic inflammatory disease of the biliary tract, accompanied by the formation of stones most often in the gallbladder (cholecystolithiasis) or bile ducts (choledocholithiasis).

The disease is based on a change in the viscosity of bile (dyscholia) associated with a violation of the physicochemical properties of bile. Stones are formed as a result of the deposition of bile pigments, cholesterol, certain types of proteins, calcium salts, infection of bile, its stagnation, and lipid metabolism disorders.

According to the World Health Organization, gallstones can be found in 10-12% of the world’s population. In advanced economies – even more often.This disease affects every fifth woman and every tenth man. Over the past decade, the incidence of this disease has doubled.

Gallstones are cholesterol (the vast majority, about 90% of the variants of gallstones), as well as pigmented and mixed stones. So, due to the oversaturation of cholesterol in bile, cholesterol stones are formed, precipitated, and crystals are formed. A disturbance in the gallbladder of the motor boat leads to the fact that these crystals are not excreted into the intestines, which ultimately leads to their gradual growth.Pigmented stones (they are also called bilirubin stones) are formed with increased breakdown of erythrocytes, which occurs with actual hemolytic anemia. As for the mixed stones, they are a kind of combination based on the processes of both forms. Contained in such stones cholesterol, bilirubin and calcium, the very process of their formation occurs as a result of inflammatory diseases affecting the biliary tract and, in fact, the gallbladder.

Causes contributing to the formation of gallstones

• unbalanced diet – predominance of animal fats
• hormonal disorders
• sedentary lifestyle
• disorders associated with fat metabolism, weight gain 90 052

• inflammation and other abnormalities in the gallbladder
• various types of liver damage
• pregnancy
• fasting
• heredity
• diabetes mellitus, etc.

Classification

Based on the features of the disease adopted today, the following classification is distinguished in accordance with the stages that are relevant for it:

1. Physicochemical (initial) stage – or, as it is also called, the pre-stone stage. It is characterized by changes in the composition of bile. There may be no special clinical manifestations at this stage, or they may be minimal. It is detected mainly by ultrasound diagnostics, biliary sludge or drying of bile in the gallbladder is determined.This stage is most favorable for drug (non-surgical) treatment.
2. The formation of stones is a stage that is also defined as latent stone carriage. In this case, there are no symptoms of gallstone disease, however, the use of instrumental diagnostic methods allows us to determine the presence of stones in the gallbladder (ultrasound diagnostics, computed tomography). Depending on the size, density of calculi, indications for drug or surgical treatment are determined.
3. Clinical manifestations are a stage, the symptoms of which indicate the development of an acute or chronic form of calculous cholecystitis. Mostly the treatment of this stage is the surgical removal of the gallbladder with stones.

Operate or not

Only a surgeon or gastroenterologist can answer this question after an individual consultation.

Medicamental litholysis

Non-surgical treatment of cholesterol stones is currently possible, but it must be timely, at the stage of formation of a soft and small stone (that is, in the first or second stage of cholelithiasis).

To determine the possibility of therapeutic treatment of cholecystitis with stones, it is necessary to study the gallbladder using computed tomography to determine the density of the stone and bile.

At the “Lotos” Medical Center, MSCT of the gallbladder is performed with determination of the density of calculi. This test has many advantages over abdominal ultrasound, because determines the density of the stone, which means its ability to dissolve. Dense, calcareous stones in Hounsfield CT units are more than 100 units and cannot be dissolved by drugs.Soft, cholesterol from 30 to 90 units can be dissolved medically. The size of the stone also matters – stones up to 10-15 mm dissolve, when the gallbladder is filled less than 1/3.

In order to dissolve small stones, preparations of special bile acids, similar to those found in human bile, can be used. Bile acid preparations are effective not only for dissolving calculi, but also for preventing their formation. They are appointed by a specialist gastroenterologist.The course of treatment is at least six months, and only under the supervision of a doctor.

Is it necessary to remove the gallbladder if the stone does not bother

Currently, the overwhelming majority of surgeons agree that patients with asymptomatic cholelithiasis should not immediately undergo prophylactic cholecystectomy (removal of the gallbladder) with a newly discovered small stone. The risk of developing severe complications with small single stones is assessed as low, therefore, such patients should regularly undergo ultrasound examinations of the abdominal cavity and follow the recommendations on lifestyle and nutrition.

In the case of calculous cholecystitis, when the patient periodically suffers from bouts of biliary colic, doctors recommend cholecystectomy, which should be performed routinely. Each subsequent attack can cause the development of acute cholecystitis, which can be accompanied by severe complications from the liver and pancreas.

If a picture of acute cholecystitis develops – biliary colic lasts more than 3 hours, the pain is localized in the right upper quadrant of the abdomen, is not relieved by antispasmodic drugs, the temperature rises, nausea and vomiting occur – an ambulance should be called.

Radical treatment of the disease

Surgery for gallstone disease is the gold standard in the treatment of this pathology. Its purpose is to remove a receptacle for calculi, avoiding recurrence of biliary colic, as well as preventing the appearance of obstructive jaundice, cholangiogenic sepsis, and biliary peritonitis. Performed in a planned manner, that is, even before the development of complications, the operation is safe. The chance of complete recovery after surgery is about 95%.

“Off”, that is, the gallbladder clogged with stones, cannot be cured without surgery.

The operation can be performed in two ways – abdominal and laparoscopic.

Abdominal operation

This is a “major” operation in which an incision is made on the anterior abdominal wall under general anesthesia. As a result of this access, surgeons can thoroughly examine and feel all biliary tract, conduct a local ultrasound or X-ray with contrast to remove all existing stones. The method is indispensable for inflammatory and cicatricial processes of the area under the liver.The disadvantages of this intervention are: a longer recovery period after surgery; a greater chance of developing incisional hernias; cosmetic defect; more often complications develop after surgery.

Laparoscopic method

The most commonly used method of surgical treatment. Surgery laparoscopy, performed for gallstone disease, is an intervention under visual control using a fiber optic device connected to a monitor through several small incisions in the abdominal wall.

The laparoscopic method has many advantages over abdominal surgery:

• the wound does not hurt so much and not so long
• it does not restrict breathing
• intestinal paresis is not pronounced
• less severe cosmetic defect

There are also negative sides to laparoscopic cholecystectomy – there are more contraindications for surgery. In particular, the laparoscopic method cannot be used not only for severe disorders of the heart, blood vessels and lungs, but also in the following cases: obesity, peritonitis, late pregnancy, acute pancreatitis, obstructive jaundice, fistulas between internal organs and bile ducts, gallbladder cancer , adhesions in the upper abdominal cavity, acute cholecystitis (if more than 2 days have passed since the disease), cicatricial changes in the hepatobiliary zone.

Regardless of how many stones are found in the gallbladder – one large or many small ones – the gallbladder is removed completely.

This is how the removal of the gallbladder looks on the monitor of the laparoscopic unit:

In our medical center, highly qualified surgeons in a high-tech surgical hospital will be able to perform cholecystectomy with the method that is necessary in your specific case.

Is it possible to live without a gallbladder

The pathologically altered gallbladder cannot fully perform its functions, and is the cause of constant pain and a source of chronic infection. Therefore, cholecystectomy, performed in accordance with the indications of a qualified physician, improves the patient’s condition and does not affect the digestive function.

If you or your loved ones have gallstone disease, you need to act quickly and correctly, without starting the disease.Correctly selected examination and treatment in our center will help to cope with the problem of gallstones.

Be healthy!

– Pirogova Irina Yurievna

90,000 Stones in the gallbladder. Why do doctors insist on removing the entire organ?

06/08/2019

Bitterness in the mouth, yellowness of the skin, and stabbing pain under the right rib most likely indicates a problem with the gallbladder.For years, stones grow in it, not giving themselves out for a long time, but at one point making life painful.

Sometimes patients think that removing the stones is enough to solve the problem. Alexey Yurievich Shapin, a surgeon at the WMT clinic, made important arguments in favor of removing the entire organ.

Stones in the gallbladder are not a cause, but an effect

Gallstone disease is, first of all, a payment for refined food. Previously, the ancestors ate raw foods, a huge amount of bile was produced to process the entire volume.Now the food is “empty”, devoid of useful microelements. This food culture leads to the development of atherosclerotic plaques in the vessels of the gallbladder mucosa. When plaque comes in contact with bile acid, stones form. If this happens, then the gallbladder has already lost its properties and does not work for the good of the body.

Removal of stones from the gallbladder leads to the growth of new

Practice has shown that when the stones are eliminated with the preservation of the gallbladder, after a while they are formed anew.This happens for one reason: the part of the gallbladder that was cut to remove stones, after suturing, becomes the main factor in crystal formation, and the process of calculus growth becomes faster. Of course, only stones can be removed, but there is no logic in this: they will reappear, and the patient must endure the risks of surgery every time.

The risk of developing oncology increases

Stones in the gallbladder are an irritating factor that provokes cancer.Long-term persistent inflammation actively affects the development of cancer of the gallbladder, cancer of the bile ducts.

Removal of an organ is quick and effective

Many people think that removing the gallbladder is long and difficult, but the operation lasts on average only 40-60 minutes. It is performed using modern endoscopic equipment, when small incisions of 5-10 mm are made on the body. Rehabilitation is quick, the patient can walk comfortably the next day.The quality of life improves, pains and seizures go away, it becomes possible to eat without strict diets.

If you are faced with an inflammation of the gallbladder, then you know how painful it is. Free yourself from pain, make an appointment with the WMT clinic surgeon by phone: 8-800-123-45-67 or leave a request on the website.
We are located at: Krasnodar, st. Guards, 33
Check-in for free parking for clinic guests from st. Pushkin.

Cholelithiasis

Gallstone disease

The gallbladder is a pear-shaped, hollow organ located on the underside of the liver.The gallbladder stores bile, which is produced by the liver and is necessary for the digestion of fats in the intestines. Bile travels from the liver and gallbladder to the intestines through the bile ducts.

If the evacuation of bile is disturbed, gallstones may form in the gallbladder. Approximately 15-20% of Russians suffer from cholelithiasis. Stones can cause pain, nausea, vomiting, and bloating, although stones do not manifest themselves in some people. However, even in the absence of any symptoms, a person with gallstones can develop dangerous complications such as purulent inflammation of the gallbladder and / or pancreas.In some cases, stones from the gallbladder enter the bile ducts and interfere with the outflow of bile and pancreatic juice. This leads to the development of jaundice and severe inflammation of the pancreas.

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is the removal of the gallbladder using special laparoscopic techniques and instruments. Laparoscopic gallbladder removal operation is a minimally invasive and less traumatic method of surgical treatment.The advantages of this operation are significantly less pain, the absence of significant postoperative scars, quick recovery after surgery, short duration (1-2 days) of hospitalization and quick (5-7 days) return to the usual rhythm of life. The operation is performed through small punctures 0.5 – 1.0 cm in size. Typically, 4 punctures are made, although the number and size of punctures may vary from patient to patient.

A video camera is inserted into the abdominal cavity through a puncture in the umbilical region.To maintain intra-abdominal pressure at the level of 8-12 mm Hg. carbon dioxide is supplied to the abdominal cavity. Using specially designed instruments, clips are applied to the duct connecting the gallbladder and the hepatic duct. The arteries feeding the gallbladder are also clipped. After removal of the gallbladder, carbon dioxide is removed from the abdominal cavity. Drainage is left in the abdomen, all wounds are sutured.

Why is the operation necessary

The operation prevents the development of serious complications that may require urgent surgical intervention.Routine surgical treatment is much safer and easier to tolerate by patients than surgery performed on urgent indications.

Most patients, after removing the gallbladder, notice a significant improvement in well-being and get rid of symptoms such as pain and nausea.

If you do not perform the operation

Gallstones are the most common cause of complications such as purulent inflammation of the gallbladder, inflammation of the pancreas and obstructive jaundice.The complexity of operations for these diseases increases many times and often requires long-term inpatient treatment. The risk of death in complications of cholelithiasis is several times greater than the risk of any postoperative complications during a planned operation.

Other treatments for gallstone disease

Medicated stone dissolution

They tried to widely use this method abroad in the mid-70s and early 80s of the 20th century.With the use of special medicines, some types of gallstones can decrease in size and even completely dissolve. The effectiveness of this method is 30%. Due to the large number of side effects and poor tolerance of the drug, it can only be used in young patients, without overweight. In 50% of patients, 3 years after completion of treatment, gallstones reappear.

According to modern treatment standards, drug dissolution of stones can be used only if a young patient refuses to undergo surgical treatment.

Open cholecystectomy

This is the removal of the gallbladder through an incision 10-15 cm long. This method also involves the removal of the gallbladder, however, the postoperative period after an open operation is more difficult, the patient requires longer hospital treatment. Therefore, this method is used only if it is impossible to perform a laparoscopic operation.

Anesthesia

The operation is performed under general anesthesia.If you have any questions or doubts about anesthesia, you should consult with an anesthesiologist.

Postoperative period

After the operation, the patient remains under the supervision of the anesthesiologist for some time, until the end of the anesthesia. After that, the patient is transferred to the ward. Most patients remain in the hospital for 48-72 hours after surgery.

Pain after surgery

In the first few days, the patient may feel some pain in the area of ​​postoperative wounds, which may require the use of pain medications.In 1-2 days after surgery, the pain should be significantly reduced. If this does not happen, the patient should immediately inform his doctor about it.

Diet and Regimen

2-3 hours after the operation, the patient is allowed to drink. The next day or the day after the operation, you can eat light food. For several months after the operation, you will need to adhere to a special diet.

The earlier the patient starts to get up, the less likely it is to develop complications from the cardiovascular and respiratory systems.At the same time, the risk of thrombophlebitis is also significantly reduced.

To prevent the development of pneumonia, it will be necessary to carry out deep breathing exercises. 10 deep breaths every hour prevents stagnation of bronchial secretions in the lungs and improves air circulation.

Smoking in the early postoperative period increases the risk of developing inflammatory diseases in the lungs.

It is recommended to measure the temperature 2 times a day for 5-7 days.

It is highly discouraged to drive a car for a week after the operation.

The recovery period usually takes 2-3 weeks. However, for 3 months after the operation, you must not lift weights weighing more than 5 kg.

Required procedures

Operational dressings are changed the next day after the operation. In the future, dressings are made as needed. The stitches are usually removed 6-7 days after surgery.

Tell your doctor immediately:

• if there is bleeding from an operating wound
• there was a fever and chills
• pain does not decrease with taking painkillers
• there is bloating
• there is redness, swelling, increased pain in the area of ​​postoperative wounds.