The gallbladder is a storage organ located under the liver and attached to it. The gallbladder stores bile, a fluid produced by the liver and essential for the digestion of food.
The formation of stones in the gallbladder is called Cholelithiasis and is a common condition. The stones that are formed are composed in 75% of cases of cholesterol and 25% of bilirubin. Cholesterol stones are formed as the liver secretes bile that is supersaturated with cholesterol, but this alone is not enough. The stasis of bile is required, the presence of small bilirubin granules that serve as nuclei around which the cholesterol will adhere and the presence of mucoproteins that help to glue the small stones together. All of the above factors are present in the gallbladder.
Bilirubin stones form in cases of cirrhosis, bile stasis, while the growth of microbes also plays an important role.
Cholelithiasis can manifest itself in 4 ways:
A. Asymptomatic Cholelithiasis.
In this case, Cholelithiasis does not present symptoms and is discovered by chance during a check-up for another health problem. In these cases, surgical treatment is not required, only periodic monitoring with ultrasound examinations. Surgical treatment is only applied to:
1. large stones (>2 cm), because they experience more frequent episodes of acute cholecystitis.
2. calcified gallbladders, because they are often associated with the occurrence of cancer.
B. Chronic Cholecystitis (Biliary Colic).
It occurs in cases of temporary obstruction of the gallbladder outlet by a stone. It is characterized by a constant pain that may or may not be associated with meals, occurs under the right flank, can last from a few minutes to a few hours and is sometimes accompanied by nausea and vomiting.
The treatment is surgical excision of the cyst, while conservative measures (drugs to dissolve the stones or lithotripsy) are not successful.
C. Acute Cholecystitis.
This is an inflammation of the gallbladder wall due to a stone becoming lodged in the gallbladder orifice. It is characterized by pain in the right upper abdomen, fever, tenderness, nausea, vomiting, and mild jaundice (yellowing of the skin). In severe inflammation, there may be perforation of the gallbladder, intra-abdominal abscess, or fistula formation between the gallbladder and another intra-abdominal organ, conditions that require immediate surgical intervention.
There are two ways to treat acute cholecystitis. The first way initially includes conservative treatment, with intravenous hydration and antibiotics and cessation of feeding, and in a second time (after approximately 8 weeks) surgical treatment, when the local inflammation has subsided.
The second method consists of immediate surgery, combined with intravenous hydration, antibiotics and cessation of feeding. Studies have shown that the second method has fewer intraoperative technical difficulties, less morbidity and a lower mortality rate. Of course, other factors play a role in the choice of treatment method, such as age, concomitant diseases and the general condition of the patient.
D. Ileum from gallstones.
This is a rare condition in which the gallstone erodes the gallbladder wall, passes into the intestine and causes an obstruction (ileus). This is a serious condition, which has a high mortality rate in the elderly (20%) and requires immediate surgery to resolve the obstruction, while the gallbladder problem is treated at a later stage with future surgery.
The treatment of cholelithiasis is now purely laparoscopic. Open cholecystectomy has a place only in case of failure of the laparoscopic approach, or in case the patient’s condition does not allow a laparoscopic approach (e.g. severe respiratory problems that prohibit air insufflation into the abdomen). In the laparoscopic approach, cholecystectomy takes place through 3-4 holes in the upper abdomen, which results in much less postoperative pain, faster mobilization of the patient, faster feeding and an equally rapid return of the patient to his normal daily life.
