Gallstones:
- Why we get gallstones
- Symptoms
- Complications of gallstones
- Diagnosis
- Non-surgical treatments
- Surgery
- Life after cholecystectomy
Surgery remains the "gold standard" treatment option for gallstones. Up until the late 1980's the procedure was performed via a large abdominal incision. This was associated with a hospital stay of up to 2 weeks and many months recovery at home. It was an operation which many people wished to avoid; preferring to live with their symptoms.
Laparoscopic Cholecystectomy:
Introduced to the UK around 1990, this surgical technique revolutionised the treatment of gallstones. So immediately better than the traditional technique that overnight it took off as the operation of choice.
The technique was refined to the point where today the vast majority of patients are able to go home the same day.
Technique:
The operation is carried out using the illustrated port positions. The camera is inserted throught the umbilical incision and the operating instruments through the other three ports.
The author's preferred technique is to use the Harmonic Scalpel for both the dissection and sealing of the bile duct and artery.
This technique, although common in Europe and the USA has been slow to take off in the UK, partly because the vast majority of surgeons performing this surgery have not developed a specialised interest in the instrument and hence do not use it routinely enough to consider it the instrument of choice for all laparoscopic procedures.
Before embarking on surgery ask your surgeon for his figures: No self respecting surgeon would be offended by this question. The numbers to be interested in are: "conversion rate" and "bile duct injuries". These should be less than 1-2 % and close to zero respectively.
The technique of the Clipless Cholecystectomy is described here: Clipless Cholecystectomy