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Common Surgically Treated Illnesses

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Gallstones are cholesterol or bile containing stones that develop in the gallbladder in response to an imbalance in cholesterol or bile metabolism. They are usually asymptomatic and are sometimes discovered during an evaluation for another reason. They may be present for years without ever causing symptoms. Once they become symptomatic they usually remain so and consideration is given at that time to removing the gallbladder. Statistically, about 1/3 of patients who experience biliary symptoms once will never have them again. One-third will develop multiple similar attacks throughout their lifetimes and 1/3 will present on a future occasion with a more serious and possibly life threatening complication of gallstones such as biliary pancreatitis or gallbladder necrosis (tissue death). The gallbladder is removed in order to prevent future attacks.

The operation is performed laparoscopically using 3 operating ports and a camera port. It is well tolerated and patients can usually go home within 36 hours of surgery. Some patients are even able to be discharged on the day of surgery. Approximately 2% of patients require conversion to an open procedure performed through either a vertical incision down the middle of the abdominal wall or a diagonal incision beneath the edge of the right side of the ribcage. This is usually required when someone has an extensive amount of internal scarring because of previous operations or because their liver and gallbladder anatomy is very unusual and the surgeon needs to literally feel his or her way through the structures for safety and clarification.

Complications of laparoscopic and open gallbladder surgery including bleeding (from either the liver surface, blood vessels supplying the gallbladder, adhesions (scar tissue), or the abdominal wall), infection (in an incision or even an abscess within the abdomen or liver if the gallbladder is infected at the time of surgery), bile duct injury or leak requiring repair either at the time if seen during surgery or at a later time if it develops later, injury to intestinal structures requiring repair or removal of the damaged structures and leakage of bile into the abdomen after surgery requiring drainage at a later date. It is also possible that gallstones may drop into the main bile duct during surgery and need to be removed after surgery with an endoscopic procedure called ERCP or endoscopic retrograde cholangiopancreatography if they cannot be removed during the operation. Lastly, it is also possible to develop stones in the common bile duct months or years after surgery but this is a rare development. Most patients have a completely uneventful operative and recovery period and experience no further issues long term.


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