Cholelithiasis or gallstones, as we say colloquially, is the formation of stones in the gallbladder.
How is it created ?
Usually the formation of stones in the gallbladder is due to the disturbance of the ratio of the components of bile. Thus, when the amount of one component increases or the amount of another decreases, conditions are created that lead to gallstones. To date, there are no effective drugs that dissolve these stones, which is why the need for surgical removal of the gallbladder is created.
Diet and cholelithiasis ?
Diet alone cannot be blamed for the creation of gallstones. But people who follow a diet high in calories, sugar and saturated fat, have an increased chance of developing gallstones. For this reason, it is recommended to avoid such foods, especially those with high fat. That is, to avoid fatty meats, eggs, milk and all high-fat dairy products. It is generally recommended to take a balanced diet with regular physical activity to maintain a normal body weight. When any of the complications described below appear, whatever diet we apply may not help relieve the symptoms and we should seek medical help.
Cholelithiasis is most often not noticed, until it is found in a random check-up, performed for other reasons, or causes some complication. Symptoms are created when a stone moves from the gallbladder and lodges in one of the ducts, tubes that carry bile from the gallbladder to the duodenum. The smaller a stone is, the easier it
can be moved.
Depending on the point where the stone will be wedged and the organ that will be affected, we will have the appearance of different symptoms. Common symptoms are:
- Pain in the upper abdomen and mainly on the right side. The pain may radiate to the middle or right shoulder blade.
- Motion sickness
- Dark colored urine, with a brandy appearance
- Yellow color in the skin and especially in the eyes
The most constant and characteristic symptom that is present in almost all patients is the pain that usually occurs after taking a fatty meal.
- Biliary colic
- Acute cholecystitis
- Gallbladder dropsy
- Gallbladder empyema
- Obstructive jaundice
- Acute cholangitis
- Acute pancreatitis
The complication that will occur, depends both on where the moved stone will wedge and how long it will remain there. When any of the above complications occur, the patient must be hospitalized to receive intravenous medication, perform the required interventions, and be closely monitored for early recognition and treatment of possible expansion of the inflammation and appearance of systemic manifestations.
Most patients who are hospitalized in a surgical clinic of any hospital today are hospitalized because of complications of gallstones
Is surgery always necessary?
The answer is yes, surgery is always required for symptomatic patients. It is not only old aged patients who are in poor biological condition due to other diseases that may coexist, in need of surgery. For these patients, there are different treatment options, apart from surgery.
For asymptomatic patients whose cholelithiasis is an incidental finding, there are specific indications as to who should be operated on and who should not. In other words, the decision for surgery is individualized for each patient and is taken in discussion with the treating surgeon.
Today, the operation is performed exclusively laparoscopically. Open cholecystectomy is allowed only when it is determined intraoperatively that laparoscopic surgery cannot provide a safe solution to the patient’s problem. For laparoscopic surgery, three or four holes, smaller than 1cm, are created lengthwise, on the patient’s abdominal wall. Through these holes, various tools are inserted into the abdomen, as well as a camera that transfers the image from inside the patient’s abdomen to a screen. The surgeon handles the tools placed in the abdomen and watching the image on the screen performs the cholecystectomy.
The patient leaves the clinic the day after the surgery, drives immediately and performs office work after 2-3 days, while eating freely. Returns to full manual activity in 15 days. As with any surgery, laparoscopic cholecystectomy can have complications, especially when the patient has a history of acute cholecystitis or gallbladder empyema. Serious complications, however, such as damage to bile or blood vessels, are very rare, about one in a thousand cases, and of course can be corrected with the right handling.
All this makes laparoscopic cholecystectomy the operation of choice for the treatment of cholelithiasis, an operation that, when performed correctly, has little chance of complications, brings mild pain to the patient and quick recovery.
Mr. Georgios Delimpaltadakis is a Doctor – Surgeon, Scientific Director of the Surgery Department of the Euromedica General Clinic Mitera Crete