The function of the gallbladder is to store and concentrate the bile produced by the liver. Contrary to popular belief, bile is not produced in the gallbladder. Between meals (in case of hunger), a very small amount of bile flows into the duodenum. After a meal, the gallbladder contracts and allows the bile it has stored and concentrated to flow into the intestine. The digestion process begins when the food broken down in the stomach encounters bile and pancreatic enzymes in the duodenum. It is known that the gallbladder empties within thirty minutes, especially after fatty meals.
Bile contains water, bile salts, proteins, fats, electrolytes and bile pigments in varying amounts. The main components that make up gallstones are cholesterol, bile pigment and calcium. In the formation of gallstones; Factors such as changing the ratio of these substances, which are found in certain amounts in the bile, structural features that prevent the regular functioning of the gallbladder, factors such as hunger, some blood diseases, parasitic diseases, heart valve diseases, genetic predisposition, play a role.
Although stones are classified as cholesterol, pure pigment, calcium - pigment stones, each group usually contains some of the other. The type of stone does not have any significance in affecting the treatment.
The probability of developing any complaints in the later years of life in people who underwent ultrasonography for other complaints and were found to have stones in the gallbladder has been reported as 20-50%. 20% of these are of vital importance.
Stones are also detected in the gallbladder in 65 - 100% of patients diagnosed with gallbladder cancer. The risk of developing gallbladder cancer in people who have gallbladder stones but have no complaints varies between 1% and 15%.
The most common form of gallbladder disease is that the stones block the blood in the gallbladder and prevent bile from being released. It occurs when the flow into the main bile duct is blocked (biliary colic). In this case, intermittent cramp-like pain in the upper right part of the abdomen is the first symptom. The pain often radiates to the right shoulder or right shoulder blade and typically lasts three to four hours. Although it may go away on its own, it tends to recur.
Treatment is removal of the gallbladder, preferably by laparoscopic (closed) method. If the blockage caused by stones in the gallbladder becomes permanent, the gallbladder expands rapidly (hydropic gallbladder), and the pain becomes permanent. A mild jaundice may occur due to infection, edema and the pressure of the gallbladder on the bile ducts.
Biliary tract infection (cholangitis), gallbladder filling with pus (empyema)< Early surgical treatment is the most appropriate approach to prevent life-threatening events such as perforation of the gallbladder, liver abscesses.
If gallstones are found and surgery is decided. There is a possibility of having a single or multiple stones in the main bile duct in4 - 12% of patients (on average, 8 out of 100 gallbladder stone patients).
Stones in the main bile duct can form within the duct, or they can occur when stones in the gallbladder pass into the duct. Jaundice occurs as a result of these stones blocking the main bile duct and preventing bile from flowing into the intestine. The duct of the pancreatic gland merges with the main bile duct and opens into the intestine (in some people, the pancreatic duct merges with the main bile duct and opens into the duodenum as separate channels in some people). Blockage of the common duct leads to the development of a much more severe disease that can be life-threatening, called pancreatitis(self-digestion of the pancreatic gland with its enzymes).
TREATMENT
The first known gallbladder surgery was performed in Berlin by the German surgeon Langenbuch in 1882, and the patient was discharged from the hospital 42 days later.Surgical technique, anesthesia, and operating room conditions have improved over the years. and thanks to laparoscopic surgery, the patient can now be discharged from the hospital the next day after the surgery.
Laparoscopic cholecystectomy (closed gallbladder surgery) was introduced by Muhe in 1985, 104 years after the first gallbladder surgery. Made in Germany in 1986 It was introduced to the world at the surgeons' congress. After the surgery performed by Mauret in France in 1987 and published in medical journals in the same year, Laparoscopic gallbladder surgery began to be performed with increasing frequency all over the world, and after 1990, it replaced open gallbladder surgery in many hospitals.
The purpose of both surgeries is to remove the gallbladder. The most important advantages of closed gallbladder surgery compared to open surgery:
- Less post-operative pain in closed surgery,
- Less risk of wound infection after closed surgery,
- Shorter recovery time after closed surgery
(in 90% of the patients, hospitalization for two days is sufficient),
- It is the opportunity to have a better aesthetic appearance after closed surgery and to return to work early.
Laparoscopic cholecystectomy; It can be safely applied to patients of all ages who have pain due to gallstones, gallbladder inflammation with or without stones, gallstone-related pamcreatitis, gallbladder polyps larger than 1cm, young patients with gallstones but no complaints, and diabetic patients with gallstones.
Since the surgery is performed under general anesthesia, its application in patients at risk of anesthesia or in patients who have previously undergone various intra-abdominal surgeries depends on the preference of the surgeon and the patient (the same anesthesia risk exists in the open surgery method).
Patients who will undergo closed gallbladder surgery are prepared for the surgery by performing preoperative tests such as blood, urine, blood biochemistry, ECG, and lung radiography, as in the open surgery method. They can be hospitalized the day before the surgery (or on the morning of the surgery) and be discharged the day after the surgery, which went smoothly.
The feature of the technique is to insert 3 pieces into the patient's abdomen without making a large incision. or with the help of a tool and camera inserted through 4 holes, the gallbladder duct and artery are ligated and cut, and the gallbladder is removed from one of the previously opened holes. In a very small number of patients (5%), the surgery is started with the decision of closed surgery and after the camera is placed, it may be necessary to switch to open surgery method due to reasons such as the anatomy not being suitable for this surgery and the presence of strong adhesions. If such a necessity arises, the surgery is performed using the open method without waking the patient. Patients who underwent closed surgery can freely consume liquid foods 8 hours after the surgery, and 95% of the patients can return to work within about a week.
Laparoscopic cholecystectomy and removal of the gallbladder by open method. When compared with each other in terms of surgery risks; It has been determined that the surgery risk is the same for both methods (1.5%), but the closed surgery method has great advantages over the open surgery method. This surgery has been described as patient-friendly by surgeons.
The average duration of the surgery is 45 – 60 minutes.
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