Diseases of the gallbladder the biliary tract, gallstones
Gallstone disease (cholecystolithiasis) with or without inflammation of the gallbladder (cholecystitis) occurs in up to 15% of the Central European population, with women being affected twice as often as men .
Gallstones are due to their nature and diet and can grow completely unnoticed for many years and suddenly, without any identifiable cause, completely regardless of their size, sometimes severe discomfort (colic) cause. The gallstones can lead to colic - caused by the closure of the duct of the gallbladder in the bile duct - inflammation of the gallbladder (cholecystitis) due to mechanical irritation of the gallbladder wall. Gallstones can also slip from the gallbladder into the bile duct and thus partially or completely block the bile duct. In this case, colic also occurs and jaundice (jaundice) and /or pancreatitis (inflammation of the pancreas) can occur as a result. Depending on the symptoms and type of illness, the appropriate therapy regime is selected and ranges from diet therapy with optional antibiotics to recovery of gallstones from the bile duct (ductus choleduchus) using ERCP followed by gallbladder surgery.
Gallstones that do not cause discomfort are certainly not automatically treatable or operated on. However, if recurring symptoms occur or inflammations occur frequently, a suitable therapy (operation) is very useful. Modern surgical techniques have so few side effects and are so well tolerated that the indication for gallbladder surgery is generally much more generous nowadays, especially since there is still no other therapy for gallstones. New, laser-based representations (NIR, near infrared) are used more and more frequently, which with the help of a special dye (ICG) make difficult gallbladder operations safe and easy to perform.
Gallbladder polyps are an increasingly common diagnosis in an ultrasound examination and are growths on the mucous membrane of the gallbladder that can potentially degenerate. Operational rehabilitation has to be considered individually.
Long-term disadvantages after gallbladder surgery are very rare and are limited to a slightly higher incidence of type C gastritis and very rarely to softer stools or even diarrhea (so-called chologene diarrhea).
Symptoms
Typical complaints are: pain in the right upper abdomen, e.g. T. radiate into the back or into the shoulder, especially after high-fat meals.
Diagnosis
The clarification takes place via blood values (laboratory) and an ultrasound from the upper abdominal organs. In the case of atypical complaints, a gastroscopy should also be performed in order to rule out that the complaints mentioned come from the stomach and not from the gallstones. A special examination, a so-called MRCP, is only to be carried out if stones in the bile duct or another pathological disorder are suspected but cannot be clearly identified. If there are stones, they can be removed using ERCP. Whether the ERCP is planned before or after a gallbladder operation (cholecystectomy) has to be decided on a case-by-case basis.
therapy
The operation itself is minimally invasive, laparoscopic either with a single incision (SILS), via 2-3 small miniports (reduced port technique ), or conventionally performed laparoscopically with 3 approaches. The gallbladder is usually retrieved via the access in the navel, as this is easily expandable and thus allows large stones to be removed without a large incision or without a scar that will later be visible. Generally I sew the accesses with the technique of a plastic surgeon. The scars are barely recognizable later, or mostly not at all.
The duration of the operation varies depending on the degree of inflammation of the gallbladder and the anatomy and is around 30 minutes on average. You do not have to worry, after the operation you will hardly feel any pain or almost no pain. In the vast majority of cases, discharge can take place on the following day. A diet should not be followed either shortly after a gallbladder operation or for a longer period.
Other diseases of the gallbladder and the biliary drainage system such as gallbladder carcinoma or cholangiocellular carcinoma are rare.
I would be happy to advise you in detail and consider with you which measure is the cheapest in your case.