Overview
Approximately 10-15 percent of the adult population or more than 20 million people in the United States have gallstones. About 1 million new patients are diagnosed annually. Gallstones are more common in women, older patients, and certain ethnic groups, and are associated with multiple pregnancies, obesity, and rapid weight loss. In 1991 approximately 600,000 patients underwent cholecystectomy (removal of the gallbladder).
Laparoscopic Cholecystectomy is a minimally-invasive surgical procedure that is performed using laparoscopic visualization of the gallbladder and surrounding vital structures. This technique requires that only a few small (about half-inch) incisions be made in the abdominal wall. The gallbladder is removed through one of the small incisions, the laparoscope and instruments are removed, and the incisions are closed with sutures and covered with small bandages.
The operation usually requires general anesthesia and is subject to the same risks and complications as open cholecystectomy. However, patients have little pain after the operation, and hospital stays (1-2 days) and recovery (1-2 weeks) are usually shorter than after open cholecystectomy. It is estimated that more than 15,000 surgeons have received some training in the technique of laparoscopic cholecystectomy, and demand for this form of surgery has escalated to the point where probably about 80 percent of cholecystectomies are being performed in this manner.
Which Patients With Gallstones Should Be Treated ?
Symptomatic Gallstones
Once gallstone symptoms appear, they recur in the majority of patients. Furthermore, patients with symptoms secondary to gallstones are more likely (25 percent within 10-20 years) than asymptomatic patients to develop complications. Thus, most symptomatic patients should be treated. Pain from gallstones ('biliary pain') is often severe, episodic, lasting 1 to 5 hours, often waking the patient at night, and located above the bellybutton ('epigastric') or in the right upper quadrant of the abdomen. Biliary pain often flares soon after eating.
Nearly 90 percent of patients with typical biliary pain are rendered symptom free after successful treatment of their gallstones. Those who are too ill to undergo general anesthesia should be managed with nonsurgical therapies.
What Are The Alternative Surgical Treatments Of Gallstone Disease ?
In the past 20 years, a variety of treatment options for gallstone disease have been developed. Open and laparoscopic cholecystectomy have become some of the safer surgical procedures as improved methods of surgical technique, better anesthesia, and management of coexisting diseases have evolved.
Open Cholecystectomy
This operation has been employed for over 100 years and is a safe and effective method for treating symptomatic gallstones. Major complications of open cholecystectomy are infrequent and include injury to the common bile duct, bleeding, biloma, and infections. Open cholecystectomy is the gold-standard against which newer surgical treatments must be compared and remains a safe surgical alternative.
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