CHOLECYSTOLITHIASIS

Introduction

Cholecystolithiasis is one of the so-called “civilization diseases”, affecting about 20% of the adult population. The incidence of the disease increases with age, though recently there has been a marked increase in cholecystolithiasis among young people. The condition more often affects women. Predisposing factors may include lifestyle, improper diet, obesity, reproductive age and hormonal drugs.

The disease involves the production of hard stones around the so-called crystallization points in bile accumulated in the gallbladder. The structure is a kind of storehouse supplying bile to the lumen of the gastrointestinal tract as needed, mainly after abundant fatty meals. Over time, crystallization points in bile become larger and larger, reaching sizes up to several centimetres in diameter.

Symptoms

Initially, the disease is asymptomatic. The first symptoms of cholecystolithiasis usually include flatulence, a feeling of pressure under the right costal arch, the lack of appetite, discomfort, rarely, sharp stinging on the right side of the abdomen. Occasionally, a stone moves into the lumen of the gallbladder neck, obstructing the bile flow. This is dangerous to health and life, as it can lead to acute cholecystitis, perforation (rupture) of the wall and diffuse peritonitis, which is a life-threatening condition requiring an emergency intervention. In order to avoid this dangerous situation, most of the patients with the symptoms of cholecystolithiasis should undergo an elective surgery to remove the gallbladder. An elective surgery is safer than an emergency procedure, as it allows the patient to prepare for the operation which is performed at an appropriate time based on a previously agreed schedule, necessary examinations and consultations are also possible. Therefore, an elective removal of the gallbladder in patients with symptomatic cholecystolithiasis is the treatment of choice.

Diagnosis

In 95% of the cases, in addition to medical history and physical examination, an abdominal ultrasound is enough to diagnose cholecystolithiasis. The condition is often detected by chance during an ultrasound examination performed for other reasons. More specialized examinations, such as computed tomography and ERCP [Endoscopic Retrograde Cholangiopancreatography] are rarely necessary.

Treatment

The treatment is based on a surgical removal of the entire gallbladder. The procedure can be performed in two ways – by laparoscopic technique or classic method. Currently, practically all patients undergo a laparoscopic surgery as the technique of choice – it is less invasive, allows for faster convalescence, minimizes the risk of wound infection, healing is more efficient than after a conventional surgery. Virtually all gallbladder removal procedures performed in our hospital are laparoscopic.

Postoperative period

A laparoscopic removal of the gallbladder is carried out on the day of admission to the hospital. After the surgery, the patient spends one night in the hospital for observation. The next morning, the drain is removed, dressings are changed, and the patient is discharged home with further recommendations regarding the care of postoperative wound and an appropriate diet. After about 10 days, the patient reports to the Outpatient Clinic, where the general condition and the correct wound healing are assessed – then, the sutures are removed and the patient returns to full activity.

In the Szpital Zakonu Bonifratrów, gallbladder removal operations are performed by doctors from the Department of General and Oncological Surgery.