The usual method for diagnosing gallstones is a sound wave picture of your gallbladder, known as gallbladder ultrasound, which is a simple and painless procedure.
If gallstones show up, and if there are no symptoms, no treatment is necessary.
If you have even one attack of biliary colic or cholecystitis, or any other complication of gallstones, treatment is advised.
Cutting Out The Gallbladder, The Old Way
There are several treatment possibilities. Traditional cholecystectomy (removal of the gallbladder) is major abdominal surgery requiring a general anesthetic and involving an incision that is six to eight inches long. The operation lasts between one-half to two hours, depending on the surgeon and his approach. The incision is generally painful for at least two weeks. The usual hospital stay following the operation is between four and six days.
The rate of complications reported ranges from 6 to 21 percent. The death rate from the operation ranges from 1 in 1,000 to 3 in a 100. It may be as high as six to eight per 100 for persons over 65 presenting with acute gallbladder inflammation.
Traditional cholecystectomy requires a recovery period of six to 12 weeks. This operation is still considered the most definitive treatment for symptomatic gallbladder disease.
Cutting Out The Gallbladder, The New Way
A better option is a new operation that removes the gallbladder through three or four small incisions, O.5 cm to 1.O cm long (less than half an inch). There is no cutting of the muscles of the abdominal wall, and there is much less pain from the small incisions. In fact, surgeons have been surprised at the extent to which pain and disability following surgery were due to the large incision.
Surgical instruments as well as a lighted instrument known as the laparoscope are inserted through these incisions. The gallbladder is cut away from the liver and removed through one of the small incisions. The surgeon views the entire procedure on a television screen.
This operation, known as laparoscopic cholecystectomy, is longer (1.5 to two hours) but there is a much faster post-operative recovery. Patients can eat the same evening and go home the day after surgery. Eighty percent of patients can return to work within two weeks.
Five to ten percent of the time, due to technical problems in removing the gallbladder through the small incisions, the incision must be enlarged to six to eight inches and thus converted into the traditional cholecystectomy. Accidental injury to the common bile duct or the intestines also requires conversion to the longer incision.
Laparoscopic cholecystectomy is rapidly becoming a popular method for removing the gallbladder in the United States and Europe, according to an analysis of the method that appeared in the April 1991 issue of the New England Journal of Medicine. This article reviewed 1,518 such operations and found that the complication rate was comparable to the more traditional type of cholecystectomy.
In Canada, at present an estimated two thirds of hospitals offer or will soon offer this type of surgery. Skilled surgeons can learn how to do this procedure quickly. However, the operation should only be performed by qualified surgeons who have completed a certified course. Ideally, such a course would require that 60 to 70 cholecystectomies be performed under direct supervision before certification, especially for surgeons with no previous laparoscopic experience.
Dr. Eldon cautions against "improperly trained individuals performing an excess of laparoscopic cholecystectomies on minimally symptomatic patients."
Long-term studies on the safety and long-term effects of this type of surgery have not yet been done. One recent series of 381 patients reported two cases of intestinal injury that resulted in death.
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