GENERAL AND LAPAROSCOPIC SURGERY

HAKAN AKINCI M.D

  • Laparoscopic Gallbladder Preserving Surgery

  • Breast Cancer Surgery
  • Laparoscopic Colon and Rectum Surgery
  • Endoscopy : Gastroscopy and Colonoscopy

Gallbladder Preserving Surgery 

Is the Gallbladder a vital organ?

Of course every organ in our body is important and all the systems are in interaction with each other.  Any dysfunction or deficiency of an organ affects the other organ and the systems negatively. The gallbladder is also a very important organ for the digestive system.

The gallbladder has these  functions which are vital for the digestive system and our biological clock; storage, concentration and when required excretion processes of the bile. By means of the gallbladder it’s possible that the bile flows into intestines intensively only in digestion period of the food. Infact the bile is a detrimental agent for our digestion cells. The existence of the gallbladder saves our digestion cells by preventing them from continuously being exposed to bile. Besides it provides our digestive system to rest by hanging the bile on in the period of the night sleep in which we stay hungry for a long time.When fatty foods reach the small intestine, the gallbladder excretes the bile to the intestine by straining. The bile cuts the fats into very small pieces by the detergent like affect. By these means fats and fat soluble vitamins are easily dispersed into the body being absorbed by small intestinal cells. This cycle is destroyed in people who had their gallbladder taken A  more fluid (having lower density) bile flows into intestines continuously. When stomach and the intestines are constantly exposed to the bile and the bile salts, it causes alkaline reflux gastritis( indigestion, swelling, reflux )or inflammation in the intestine (swelling, diarrhea). Due to the fact that the density of the bile is low, the fats cannot splinter and be digested effectively.

As a result of this situation, %40 of people who had their gall taken, have digestive  complaints like indigestion to fatty foods, stomach ache, swelling, diarrhea or oily defecation.

Is it possible to take the gallstones without taking the gallbladder? Which patients are suitable for this operation?

The gallbladder coordinates with all the organs and all the systems in our body; especially with the digestive system. Any disorder in other systems affects the gallbladder. The disorders occurring in the digestive system due to the malnutrition or our body being exposed to toxins causes chronical inflammation and functional disorder in the gallbladder as it happens in all systems. As a result of chronic inflammation the cholesterol, the bile acid and the liver metabolism are influenced and cause gallstones in the gallbladder and chronic inflammation. It also occurs other systematical disorders in high level in the patients who have the gallstones in their gallbladder. It is not a right approach to charge only the gallbladder for the existence of the gallstone.

The principle must be to save the organ.
That’s why if there’s no emergency to take the gallbladder, for the patiens who have the properties below, just the gallstone can be taken by saving the gallbladder. The medical precautions for the gallbladder and the other system disorders should be apllied before the operation and proceed after the operation.

*Patients not having the gallbladder inflammation or cholecystitis attack
*Patients not having the gallstone story in their families’ several members
*Patients not having ERCP in their main bile duct
*Patients not having the cancer suspecion
*Patients not having accompanying check up or tough chronic disease(obesity, diabetes, heart disease or liver failure ect.)
*Patients not having an operation of hypochondrium

*Patients having the normal gallbladder function and wall thickness in ultrasonography
*Patients having less than 3 gallstones are suitable for the preserving surgery

How are the patients prepared for the gallbladder preserving surgery?

By an elaborate examination and medical work up, existing systematic disorders (stomach and intestinal system, hormonal system, neurological system) are determined.

By means of the ultrasonography, the structural features and the functions of the gallbladder are evaluated. The number of the stones are detected. The diet and the life styles of the patients decided suitable for the operation should be arranged.

The vitamins and minerals lacking in the body should be replaced. The patients should be watched carefully, until the disordered systems and organs heal. When the precautions succeed, the gallstone removing surgery can be arranged by evaluating the functions of the gallbladder. The preoperative period is organised according to the medical condition of the patient.

How is the gallbladder preserving surgery done?

The gallstone removing surgery is done under general anaesthesia, by means of the tiny holes opened from the abdominal wall with laparoscopic surgery.

The number of the orifices opened from the abdominal can vary according to the situation of the gall bladder. Usually two holes are enough. During the operation camera systems and special laparoscopic tools are used. The small cut is done from the top of the gallbladder. The stones are taken by getting into the gallbladder with the camera. Also when a polyp is detected in the gallbladder, the polyp can be taken out with the same process and the pathological examination can be done during the operation. When it is ensured that there is no gallstone left in the gallbladder and in the gallbladder duct, mucosa and serosa layers are closed by sutures which are absorbed separately. The orifices in the abdominal wall are closed by stitching,too.

What are the complications of the gallbladder preserving surgery?

The ratio of the complications of the gallbladder preserving surgery is lower than the ratio of the gallbladder removal (Cholecystectomy). Some complications can occur due to the general anesthesia. After the gallstone is taken out, the orifice opened to the gall blader is closed by stiching. In the cases around the world no bile leakage was obsesrved from this stiching point. However there is a possibility like this. In a situation like this, the gallbladder must be taken out. Rarely there could be a risk of stone falling into the main bile duct. Some complications like wound infection, bleeding and hernia can seldom occur.

What is the risk of recurring of gallstones after being taken out?

Recurrence of the gallstones in the pursuits from one month to ten years is between %5-30. Due to attentive patient selection, following nutrition and support advices pre and postoperative, the recurrence of the gallstones will decrease. When recurrence arises, it can cause some problems that we have referred to in the part ‘What kind of disorders could the gall stones cause?’. In the researches it is declared that the recurring stones are mostly asymptomatic (not causing complications) stones. In the event of complication, the cure is to take the gall blader out.

About the Gallbladder

What are the functions of the gallbladder?

The main function of the gallbladder is the bile storing during the hunger and to make the bile concentration during this period of waiting. The waiting of the bile during the hunger is for the rest of the digestive system and for the digestive hormons not to be released unnecessarily. The concentration of the bile is to facilitate the absorption from the instentines by breaking the fat effectively.

These two functions have these advantages;

*They provide the digestion of fats
*They take part in the absorption of the fat soluble vitamins (A,D,E,K vitamins)
*The save the bile salts in the bile and liver, stomach, the inner layer of the small and large instentines by being effective in the cholesterol metabolism.
*The intensive flow of the bile to the instentine by the contraction of the gallbladder accelerates the digestive system by increasing the instentine activities.
*It is emphasized in the current studies that the gall bladder has influence on our immune system,too.

In the event of eating, a hormon called cholecystokinin provides the flow of the bile to the duodenum by contraction of the gallbladder. The bile flown to this part provides the absorption of fats and fat soluble vitamins.

What types of the gallstones exist?

Cholesterol gallstones: It is the most common gallstone type. Generally it has the different tones of the colour yellow. The gallstones occur, when the bile involves not dissolved cholesterol in high levels. They improve due to the high calorie diet, high blood cholesterol, obesity, fast weight loss, inflammatory bowel disease, intestinal disbiosis, estrogen treatment in high doses and genetic predisposition.

Pigment gallstones: They are dark brown or black stones occuring in the conditions of the bile involving bilirubin in high rates. They improve due to the blood diseases, chronical bacterial or parasitic infections.

What is the mechanism of gallstone formation ?

The gallbladder is an organ that functions in interaction with all the organs and systems in our body.
A disorder in the other systems affects the gallbladder,too. The disorders in the digestive systems cause chronic inflammation and functional disorders in the gallbladder as they do in all the systems in our body. The cholesterol, the bile acid and the liver metabolism affected due to the chronic inflammation causes the stones and chronic inflammation in the gallbladder whose function was ruined.

The cholesterol is not a water-soluble substance. It is moved compound with other substances to be moved soluble in the bile. The bile involves water, cholesterol,the bile salts, lecitin, electrolites and bilirubin. The rate of this contents is fixed. Generally due to the changes in the increase of the cholesterol in the rate of the cholesterol- the bile salt- lecitine, the mud, crystal and later cholesterol stones occur in the gallbladder. It is a wrong and an incomplete approach to charge the gallbladder for the improvement of the gallstone or to assume that when the gallbladder is taken out all the problems would be eliminated.

Which patients have the gallstones more often?

Women have the gallstones more often. It is marked that especially women over the age of 40, blonde, fat, having the hormon treatment, have the gallstones more often. The ratio of having gallstones increases during pregnancy. Any disorder in our body systems, affects the gallbladder functions as it happens in the other organs. For this reason any person who has irregular eating habit, problems in the digestive system organs, insulin resistance or diabet, takes often medicine, sedentary life style, the high possibility to have the gallstone.

Do the medicine cause the gallstones?

The medicine including estrogen hormon and birth control pills: The estrogen preparations used as derma-bands increase the risk less. The lipid lowering medicine(involving clofibrate), Tamoxifen. It is stated that the risk of gallstones increases when people take this medicine.

What kind of disorders may the gallstones cause?

The gallstones may not cause any disorders for many years or they can cause chronic inflammation in the gallbladder as they create complaints like stomach complaints so the patients cannot realize the condition.

*Digestive problems;
The gallstone can cause complaints like stomach ache affecting the dorsum, swelling,nausea starting around 30-45 min. after the meal.

*The gallbladder inflammation (Cholecystitis);
The gallbladder inflammation improves due to the obstruction of the gallbladder duct by the gall stone. It shows indications as a severe stomach ache affecting the dorsum on the right part of the abdominal, high fever, nausea-vomiting.

*The Icterus:
The icterus may occur due to the stone falling from the gall bladder to the main bile duct.

*The Pancreatitis;
The small stones falling into the main bile duct and from there to the duodenum may cause an inflmmation in the pancreatic duct.

*The gall blader cancer; It is marked that the stones larger than 2 cm. are more often in assosication with the gall bladder cancer.

Can the gallbladder sludge or the gallstones be dissolved?

The dissolving treatment can be administered in the pure small cholesterol stones that do not involve calcium.
The achievement drive with the medicine like ursodeoxycholic acid or chenodeoxycholic acid.

Laparoscopic Cholecystetomy

How is the cholecystectomy (gallbladder removal surgery) done?

It is done under general anesthesia, by 3 or 4 orifices opened to the abdominal wall using laparoscopic tools. The gallbladder channel and the vessels are cut by special tools called clips. The gallbladder is put into a plastic bag and taken out of the abdomen. The orifices are closed by stitches

What are the complications of the gallbladder removal surgery?

Some complications can be seen due to the general anesthesia. During the operation, there can be the organ injury, the main bile duct injury and bleeding. If the gall stone falls into the main bile duct, it can cause cholangitis or pancreatitis after the operation. It can be seen the postoperative bile leakage. The stenosis or cholangitis can occur in the main bile duct. Intraabdominal abscess can be developed

What kind of damages to the body can present after the gallbladder is taken out?

The gallbladder is an important organ which has substantial functions for all body systems initially for the digestive system. It functions in interaction with the all the organs and systems in our body. Any disorder or deficieny in the other systems affects the gallbladder, the absence of the gallbladder affects the other organs and systems. The % 30-40 of the patients whose gallbladder was taken out, have digestive problems going on due to no concentration of the bile and continiously flowing to the intestines. Especially a deficiency in the digestion of fats develop and oily defecation occurs. Besides the deficiency of vitamins A,D,E,K can be seen. Fluid and continiously flowing of bile forms reflux to the stomach and develops alkaline reflux gastritis by causing damage to the stomach cells. This situation shows indication as indigestion,swelling especially after fatty foods. The number and variety of microbial floras in our instentines is damaged due to the lack of gallbladder. The damage of the flora can cause obesity that we called metabolic sendrom, hipercholesterolemia and insulin resistance.

What kind of a diet should the patients have after the gallbladder removing surgery?

Getting sick of the gallbladder is a reflection of a deficiency of the other systems, mainly of the digestive system. That’s why we cannot say that the patient whose gallbladder was taken out can heal. The factors giving harm especially to the digestive system and the other systems must be eliminated.
The patient should avoid eating foods which he/she has intolerance. Harmfull foods cause insulin resistance and chronical inflammation as they do in the gallbladder and in the all body. This foods are generally gluten, milk, sugar and harmfull trans fatty acids. It must absolutely be avoided from this kind of foods.
The patients having their gall blader taken out must not avoid consuming the healthy oil (butter, olive oil, coconut oil, falw seed oil) even though they may experience disorders in the fat digestion. The patients should eat more often and in less portions. They can eat egg.

Gallbladder Polyps

What is the gallbladder polyp?

They are skin tag like formations occuring on the inner gall bladder wall. They can be easily noticed by ultrasonography.

How are the gallbladder polyps treated?

The %95 of the gallbladder polyps are benign. According to the size of the polyp, the becoming cancer increases. On the other hand the gallbladder
cancer is a very rare disease. The patients having polyps smaller than 1 cm can be followed not being treated. The polyps larger than 1 cm should be treated.
The standard treatmant is to take the gallbladder out. Yet only the polyp can be taken as laparoscopic and it can be decided wheter to take the gallbladder
according to the patology results.

Please contact us for more information.

Surgimed Clinic , Op. Dr. Hakan Akıncı
Hakkı Yeten Cad. Fulya Aşçıoğlu Plaza No:10 Kat:1 D:3 Şişli – İstanbul
Tel : +90 212 231 80 71