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Gall Bladder Stone Surgery

What is Gallbladder?

Gall-bladder is a pear shaped small organ lies just below liver on right upper abdomen. It’s attached to right side of liver and with bile-duct via cystic duct.

The size of gallbladder in adult is approximately 7 to 10 centimetres (2.8 to 3.9 inches) in length and 4 centimetres (1.6 in) in diameter when fully distended.

Gall Bladder

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Dr.Avinash Tank

Dr. Avinash Tank

MBBS, MS, MCh (SGPGIMS)

(Surgical Gastroenterology & Liver Transplantation)

Dr Avinash Tank, is a super-specialist (MCh) Laparoscopic Liver, Gastro-intestinal & Obesity Surgeon, who has in-depth knowledge of disease of digestive organ and their treatment. He has been trained at most prestigious centre of country (SGPGIMS) & Abroad (Japan & South Korea). He is the recipient of many awards at various prestigious international and national conferences.

Dr Avinash Tank is having vast experience to treat all surgical disease (like Obesity, Stones & Cancer) of Liver, Gall-bladder, & Gastro-intestinal organs by Endoscopy or by Laparoscopic (Key hole) surgery. Dr Avinash Tank has credit for removal of more than 1000 stones of Gall-bladder.

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15 years of Experience

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More than 5000 Surgeries

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Satisfied 20000 Families

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Best Surgeon Award by FM Radio

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About of Dwarika

Dwarika Hospital, is a super-speciality hospital at Ahmedabad at the heart of Gujarat, India. Dwarika Hospital is having most experienced and super-specialist laparoscopic Gastrointestinal surgeon along with team of Physician, Diabetologists, Intensivist, Dietician and specialized Physiotherapist to take care of all & high-risk obese person.

Dwarika Weight loss Centre is the best Obesity Surgery Centre in Ahmedabad, Gujarat, India. Dwarika Weight Loss Surgery Centre is equipped with all latest equipment’s & facilities to deliver world class quality treatment at affordable cost in India....

Dwarika hospital is the preferred destination for medical tourism in India. Dwarika hospital is providing state of art care for disease of Liver, Gastro, Gall-bladder stone, Acidity (Reflux/GERD), Appendix, Hernia & Cancer of any digestive organs like Liver, Pancreas, Stomach, Colon& Rectum. We have treated patients from all sphere of globe: USA, Canada, London, Africa, Nairobi (Kenya), Dar se Salaam (Tanzania), Kampala (Uganda), Maputo (Mozambique), (Madagascar), Dubai (UAE), Australia. Dwarika Hospital also provides online consultations for all type of disease of Liver & Gastrointestinal organs like Jaundice, Acidity, Constipation, Diarrhea, Tummy pain & Weight loss.

Function of Gallbladder

Function of Gallbladder

Bile is made in Liver, not in Gallbladder and its pass through bileduct to gallbladder.

Gall-bladder stores bile (juice formed by liver) and help in digestion of fatty meals. Gallbladder release the bile for digestion when food reaches to duodenum and gallbladder contract to push bile to travel through bile duct to reach into duondenum.

Development of stones in gall-bladder indicates malfunction of gall-bladder and surgical removal of gall-bladder is easily tolerated by the body thus person can live normal life after gallbladder removal.

What is Gallbladder Stones (Cholelithiasis) or Sludge ?

Gallbladder stones are madeup of concretion of cholesterol or bile pigment or mixture of both.

Gallbladder stones size can variable. It may be very small (1 mm) or very large (>3 cm). One person can have stones of different size.

Size of stone have bearing with symptoms: Smaller the stone, have tendency to cause jaundice or pancreatitis more often during their passage with bile. Larger stones can cause blockage of neck of gallbladder and larger stone > 1 cm size is well known risk factor for cancer of gallbladder.

Gallbladder Stones
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Type of Gall-stones: Gallbladder stones are composed of cholesterol or bile pigment.

Cholesterol gallstones develop when bile contains too much cholesterol and not enough bile salts. Risk factors for cholesterol stones are obesity, women taking estrogen either as family planning pill or for peri-menopausal hormonal supplement, diabetic person and those losing weight rapidly. Healthy lifestyle may minimize the development of cholesterol gall-stones.

Pigmented stone are made up of bilirubin and risk factors for pigment stones includes hemolytic anemias (such as sickle-cell disease and hereditary spherocytosis), cirrhosis (Liver failure), and biliary tract infections.

Mixed stones, is the most common type seen in Indian-Asian population. They are composed of both cholesterol and salts.

Risk Factor to develop Gallbladder stones (Cholelithiasis):

Risk factor for stone formation is also depends upon type of stone.

Risk factor for Cholesterol Gallbladder stones are

Western Population

Age: more common in the 30's & 40's.

Sex: Women between 20 and 60 years of age are twice as likely to develop gallstones as men.

3 F Acronym: Fat Female in Fertile age

Hormonal Imbalance:

  • Excess estrogen (women on oral contraceptive pills).
  • Pregnancy (Pregnancy & Gallbladder Stone Surgery).
  • Female Gender

Metabolic Cause:

  • Obesity
  • Diabetes (Diabetes & Gallbladder Stone Surgery)
  • High Cholesterol level

Gall bladder Stasis:

  • Rapid weight loss: Very Low Calorie diet, Bariatric Surgery
  • Octreotide medicine,
  • Spinal Cord Injury,
  • Low physical activity, Prolonged fasting,
  • Total Parenteral nutrition
  • Previous Surgery (Truncal Vagotomy for Duodenal Ulcer

Genetic: Familial history, Maternal side

Diet: Diet to prevent Gallbladder stones

  • High calorie, High cholesterol, high carbohydrate and low fibre diet.
  • Low Vitamin C intake, Low Iron diet, Low Vitamin D level

Risk factor for Pigmented Gallbladder stones are

  • Asian Population
  • Hereditary blood disorders (Hemolytic Anaemia)
  • Biliary tract Infection
  • Liver Cirrhosis & Hepatitis C infection
  • Inflamatory Bowel Disease (Loss of Bile Salt)
  • Ileal Resection or Ileal Bypass(Loss of Bile Salt)

Symptoms of Gallbladder stones(Cholelithiasis)

Symptoms of Gallbladder stones

The most specific symptom of Gallbladder stones is Biliary Colic, also know as "gallstone attack".

Biliary Colic is an unforgettable intense pain in the upper-right side of the abdomen, often accompanied by nausea and vomiting, that steadily increases for approximately 30 minutes to several hours. Often, attacks occur after a particularly fatty meal.

Other symptoms include abdominal bloating, intolerance of fatty foods, belching, gas, and indigestion.

Some person may found to have gallbladder stones when they undergo investigation like USG or CT scan for other illness but they remains asymptomatic.

Complications of Gallbladder stones (Cholelithiasis):

Some person may progress to complications of Gallbladder stones after first attack of biliary colic. Also others can present first time with Complications of Gallbladder stones.

Acute Cholecystitis:

Acute Cholecystitis (Inflammation of the gallbladder). A gallstone that becomes lodged in the neck of the gallbladder can cause inflammation of the gallbladder (cholecystitis). In some case this may lead to pus formation in gall-bladder, leading to severe pain and fever that require hospitalisation and treatment.

Jaundice:

Jaundice & Cholangitis (Blockage of the common bile duct& Fever). Gallstones can block the tubes (ducts) through which bile flows from your gallbladder or liver to your small intestine. Jaundice and bile duct infection (Cholangitis) can result.

Complications of Gallbladder stones

Pancreatitis:

Acute Pancreatitis (Blockage of the pancreatic duct). The pancreatic duct is a tube that runs from the pancreas to the common bile duct. Pancreatic juices, which aid in digestion, flow through the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (Pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.

Cancer:

People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small. Single large stone > 1 cm size is a well established risk factor for Gallbladder cancer. Other risk factors for Gallbladder cancer are associated polyps >1 cm, calcified GB (13–22%), large stones >3 cm (10 times risk), GB packed with stones, and ethnic groups in high-incidence GBC areas like Ganga-belt in India.

Diagnosis of Gallbladder stones(Cholelithiasis):

Ultrasound is the most useful test to identify gallstones. Sometime MRCP / ERCP may be required to look for presence of stones in common-bile duct (CBD).

Routine blood test (CBC) AND Liver function test (LFT) are done to look for any infection / jaundice.

Diagnosis of Gallbladder stones

Treatment of Asymptomatic Gallbladder stones(Cholelithiasis)

Asymptomatic gall-stones are usually observed because they have very small risk to progress to develop complications.

Only high risk asymptomatic patients (those having more probability to develop gall-stone related complications) are advised for surgery. These conditions are Porcilin (Calcified wall) gallbladder, Chronic haemolytic Syndromes, Peri-operative discovery of gallbladder stone during abdominal surgery, organ transplant recipients, common bile duct stones.

Patient with Diabetes and Liver disese (Cirrhosis) were earlier advised to undergo surgery soon after diagnosis, but now thay are advised early surgery for their Gallbladder stone symptoms.

Treatment of Symptomatic Gallbladder stones(Cholelithiasis)

Surgery

Symptomatic patients should consult to medical expert for surgery. Laparoscopic (Key hole) gall-bladder surgery is a worldwide accepted treatment.

Medicine & Treatment of Gallbladder stones ( Stone Dissolving Therapy):

Stone dissolving therapy in ineffective for mixed and pigmented gall-stones and has inconsistent result for cholesterol stones. Inability to identify stone composition and high prevalence of mixed stones, limits the use of “stone dissolving therapy” in Indian-Asian population.

Laparoscopic Gallbladder Stone Surgery

Laparoscopic surgery is a minimally invasive approach of surgery.

Several small incisions are made in the abdominal wall, through which are inserted tubes that allow the passage of the surgical instruments needed for the operation.

A small camera is inserted into the abdomen, and the surgeon operates by watching his activities on a video monitor. To enhance his vision, your abdomen in inflated with gas, and as much as possible of this is expelled again at the end of the operation.

Mostly 4 trochar are placed to perform safe laparoscopic gallbladder surgery. Its also called as Multiport Gallbladder stone Surgery. Technological innovation has made it possible to do surgery by single port surgery. Difference between Single port Vs Multiport Cholecystectomy is seen in term of less post-operative pain but it required additional port (trochar) to get help to complete the surgery.

However you may feel a bit bloated, or have “wind” pains under your diaphragm or in your shoulder tip for a few days whilst any final gas bubbles are slowly reabsorbed.

Compared to open surgery, benefits of laparoscopic Gallbladder stone surgery include

  • Less post-operative pain
  • Better cosmetic results
  • Fewer wound infections
  • Fewer incisional hernias
  • Faster recovery and return to pre-surgical levels of activity
Laparoscopic Gallbladder Stone Surgery

Preparation for Gallbladder stones Surgery

Our expert team members shall help you to prepare you for surgery. You are strongly advised to stop smoking, stop drinking alcohol, try to improve your diet, lose weight, or actively exercise before surgery.

1. Pre-operative testing

In most cases, you will need some tests before your surgery. The tests routinely used include:

Blood tests to measure your blood counts, your risk of bleeding or infection, and how well your liver and kidneys are working.

Chest x-ray and ECG (electrocardiogram) to check your lungs and your heart’s electrical system.

USG (UltraSonoGraphy) is the standard test to know about gall-bladder stones.

2. Anaesthetic Assessment before Surgery:

Our expert team of Anaesthetist will ask you questions pertaining to your health and to assess your fitness for surgery. You are requested to tell them in detail about your current and past medical ailments, allergic reactions you’ve had in the past and current medicines that you are taking like blood thinning medicine. This medicine should be stopped 1 week prior to surgery.

3. Informed Consent

Informed consent is one of the most important parts of “getting ready for surgery”. It is a process during which you are told about all aspects of the treatment before you give your doctor written permission to do the surgery.

4. Getting ready for Surgery

Depending on the type of operation you have, there may be things you need to do to be ready for surgery:

Emptying your stomach and bowels (digestive tract) is important. Vomiting while under anaesthesia can be very dangerous because the vomit could get into your lungs and cause an infection. Because of this, you will be asked to not eat or drink anything starting the night before the surgery.

Laxative: You may also be asked to use a laxative or an enema to make sure your bowels are empty.

Shaving of Operative part: You need to have an area of your body shaved (hair-clipping) to keep hair from getting into the surgical cut (incision). The area will be cleaned before the operation to reduce the risk of infection.

Anaesthesia for Gallbladder Stone Surgery

Anaesthesia is the use of drugs to make the body unable to feel pain for a period of time. General anaesthesia puts you into a deep sleep for the surgery. It is often started by having you breathe into a face mask or by putting a drug into a vein in your arm. Once you are asleep, an endotracheal (ET) tube is put in your throat to make it easy for you to breathe. Your heart rate, breathing rate, and blood pressure (vital signs) will be closely watched during the surgery.

A doctor watches you throughout the procedure and until you wake up. They also take out the ET tube when the operation is over.

You will be taken to the recovery room to be watched closely while the effects of the drugs wear off. This may take hours.

People waking up from general anaesthesia often feel “out of it” for some time. Things may seem hazy or dream-like for a while. Your throat may be sore for a while from the endotracheal (ET) tube.

Recovery after Gallbladder Stone Surgery

Pain

You may feel pain at the site of surgery. We aim to keep you pain free after surgery with the help of latest and most effective technique or analgesic (pain relieving medicine).

Eating and Drinking

You will be allowed orally liquids once you recover from effect of anaesthesia medicine and you don’t have nausea or vomiting. Gradually you can add soft to normal diet.

Activity

Our health care team will try to have you move around as soon as possible after surgery. You are encouraged to get out of bed and walk the same day. While this may be hard at first, it helps speed your recovery. It also helps your circulation and helps prevent blood clots from forming in your legs.

Going home

Once you are eating and walking, and then you are ready to go home, in most case in next day following surgery. Before leaving for home our health care team shall give you detailed guidance regarding diet, activities, medications & further plan of treatment.

Bath (Shower)

We apply waterproof dressing over operation site (wound). So you can take daily bath (shower) at home.

Risks and side effects of Gallbladder Stone Surgery

There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. What’s important is whether the expected benefits outweigh the possible risks.

Complications in major surgical procedures include:

Complications related to Anaesthesia: Reactions to drugs used (anesthesia) or other medicines. Although rare, these can be serious because they can cause dangerously low blood pressures.

Complications related to underlying medical illness like heart disease, diabetes, kidney disease, obesity, malnutrition.

Complications related to Specific Operations: You are encouraged with discuss in detail with our health care team before you give your consent for surgery.

Conversion to open surgery: Although experienced surgeon can perform laparoscopic gall-bladder surgery, but are some situations that may justify to convert to open surgery like densely adherent nearby organ to gall-bladder that make identification of gall-bladder difficult to execute safe surgery.

  • Bile leakage after surgery: The BDI rate is 0.19%
  • Infection
  • Bleeding
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