Gall Bladder Surgery

What is Gall bladder and biliary tract surgery?

Gall bladder stones is an extremely common condition especially in young women and are usually asymptomatic. Some patients experience biliary colic, an intermittent and often severe pain in the right upper abdomen, and at times between the scapula because of temporary obstruction of the cystic duct with a gallstone.

If the cystic duct obstruction persists, the gallbladder becomes inflamed and the patient develops cholecystitis, an acute inflammation and infection of the gallbladder.

These stones can sometimes slip into the common bile duct and cause obstructive jaundice. Rarely these stones can block the pancreatic duct opening and cause acute pancreatits which is a life threatening condition.

Signs and Symptoms

The vast majority of patients with gallstones are asymptomatic. Symptomatic gallstones typically manifest with right upper quadrant abdominal pain, often accompanied by nausea and vomiting.

The pain is often severe, may abate over several hours (biliary colic), or may progress to cholecystitis, with persistent pain and fever. On examination, there is pain on palpation of the right upper quadrant (Murphy's sign).

Ocassionally these patients may be jaundiced as well. Sometimes the gall bladder maybe palpable when it is distended.

Diagnosis

The imaging study of choice is a right upper quadrant ultrasound, which, in the presence of cholecystitis, typically shows the presence of gallstones, a thickened gallbladder wall, and pericholecystic fluid.

In those patients with symptomatic gallstones and a negative ultrasound examination, endoscopic ultrasound may be helpful. 2 To confirm the suspicion of cholecystitis, a hydroxyiminodiacetic acid (HIDA) scan can be useful.

The radionuclide material is concentrated in the liver and excreted into the bile but does not fill the gallbladder because of cystic duct obstruction.

Acute Cholecystitis

Acute inflammation of the gall bladder due to gall stones blocking the outlet of the gall bladder. The gall bladder is usually swollen, tender to touch.

The patient is usually sick with fever and severe abdominal pain. An ultrasound of the abdomen will accurately diagnose acute cholecystitis.

This condition will require treatment right away in the form of a cholecystectomy and antibiotics.

Treatment

The primary treatment for symptomatic gallstone disease is cholecystectomy or removal of the gall bladder.,. Most cholecystectomies in the World are done laparoscopically. An occasional patient will require an open cholecystectomy.

Common bile duct stones can accompany acute cholecystitis in up to 10% of cases. These stones can be removed endoscopically before or after cholecystectomy, or surgically at the time of laparoscopic or open cholecystectomy.

Most good-risk patients who undergo elective laparoscopic cholecystectomy are sent home within 24 hours. Patients who undergo open cholecystectomy may require hospitalization for several days.

Dr.Radhakrishna is an expert in laparoscopic gall bladder surgery. He is one of the very few surgeon performing this operation on a day care basis. performing this operation on a day care basis.