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Gall Bladder Surgery

Gall Bladder Disorders

The gall bladder sits beneath the liver. It acts as a reservoir for bile and digestive juices, but is not essential to normal digestive function. It empties into the digestive tract via the cystic duct and the common bile duct. It contracts in response to a meal, and fatty foods appear to provoke contraction particularly strongly.

Stones form in the gall bladder as a result of concentration imbalances of bile pigments, salts and cholesterol. In some cases, there is only a single stone. In others, there may be hundreds of stones. Many stones appear never to cause health problems.

Stones may be free floating in the gall bladder. On gall bladder contraction, they act as a ball valve to prevent emptying and thus cause pain. This is biliary colic. Where infection supervenes upon the static bile, cholecystitis occurs. This is associated with prolonged pain and fever.

Stones may also pass into the common bile duct, where they may cause blockage of the drainage of the liver and thus jaundice.

Anatomical variants of biliary tract anatomy are common and can cause technical problems at surgery.

Cancer of the gall bladder is very rare.

The Diagnosis of Gall Stones

Most stones are diagnosed by an ultrasound scan.

Blood and urine tests help to confirm the diagnosis of obstructive jaundice.

The telescopic technique of endoscopic retrograde choledocho-pancreatography (ERCP) allows imaging of stones in the common bile duct. It may be combined with a variety of techniques to remove stones, or to bypass them with stents in severe cases.

Treatment options for symptomatic gall stones
Surgery is the only effective long term solution for gall stone problems. Dissolution using a variety of invasive and non-invasive (dietary) strategies is not effective. Extra-corporeal Lithotripsy, which works well for kidney stones, is much less effective for gall stones.

Surgical strategy is to remove the gall bladder for uncomplicated gall stones confined to the gall bladder. A number of options are available for the removal of stones in the common bile duct. These include:
-removal of the stones prior to surgery by ERCP
-Removal of the stones at open or laparoscopic surgery

Laparoscopic gall bladder surgery

Laparoscopic surgery has become the approach of choice for uncomplicated gall bladder disorders

This usually involves four small incisions, through which a telescope attached to a digital camera, and a variety of delicate instruments can be introduced to detach and remove the gall bladder.

Laparoscopy is performed under two dimensional imagery, and remotely from the surgeonís hands. Occasionally, technical difficulties or unexpected findings can oblige conversion to open surgery, using a longer incision, allowing the surgeon direct access to the tissues.

Open Gall Bladder Surgery

Until the early 1990s, almost all gall bladder surgery was performed through one of a variety of conventional, long access incisions. This remains a valuable approach in a number of circumstances, which include:
-abdominal scarring from previous major surgery
-the treatment of cancer
-dealing with anatomical anomalies and complications of surgery
-dealing with severe gall bladder disease resistant to laparoscopic instruments and techniques
-dealing with gall stones in the common bile duct


Text provided by Mr David Rew, Copyright 2003


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