Dr AvinashTank, is a super-specialist (MCh) Laparoscopic Gastro-intestinal Surgeon,

Gall Bladder Stone Surgery

80 years old, heart patient. Nevertheless, a ruptured gall bladder was successfully treated with binoculars.

Celebrity who has same disease

manojkumar-11

Manoj Kumar
( Bharat Kumar)

75 year old Veteran Bollywood actor Manoj Kumar underwent gall bladder surgery at a suburban hospital in Mumbai.
Mary kom

Mary Kom

Mary Kom has surgery to remove gall bladderOlympic bronze medalist boxer MC Mary Kom had her gall bladder removed after undergoing keyhole surgery.A report in the Times of India says that the procedure was done at the private Shija Hospital and Research Institute (SHRI) in Imphal.Her husband Onler Kom said that she has been complaining of abdominal pain over the last few months.
priyanka gandi vadra

Priyanka Gandhi Vadra

NEW DELHI: UPA chairperson Sonia Gandhi's daughter Priyanka Gandhi Vadra underwent a surgery of the gall bladder at Sir Ganga Ram hospital in the capital on Monday. Hospital authorities said that the 41-year-old was diagnosed with stones in the gall bladder recently after which it was decided to conduct a minimally invasive surgery. Her condition is said to be stable post-surgery.

Amazing Facts About Gallbladder

Most gallbladders are roughly 1 inch wide and 3 inches long, there are notable exceptions.
Largest gallbladder, was 12 inches long and it was removed from a woman in India, making it the longest gallbladder in the world.

Gallstones are common in young overweight female of fertile age, under forty year of age. Simple acronym used by medical students as 4 F: Female, Fertile, Fatty, Fourty

Gallbladder is not essential for life. One can have healthy life without gallbladder. It’s so because it doesn’t perform any essential function in human body. It’s role is just to store bile , which is made in liver & release in intestine when food reaches there for digestion

He was died because of spread of infection following rupture of infected gallbladder.

In 1987, an 85-year-old woman complaining of severe abdominal pain showed up at Worthing Hospital in West Sussex, England, and doctors found a shockingly high number of gallstones—23,530, to be exact.

4 Reason for Early Treatment of Gallbladder Stone

Complications of Untreated Gallbladder Stones

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.

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.

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.

CHOLESTEROL GALLBLADDER

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

PIGMENTED GALLBLADDER

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)

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.

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.

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

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.

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.

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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.

Bath (Shower)

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

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.

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
  • DR. AVINASH TANK

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