Benign diseases of the gallbladder and more specifically cholelithiasis and polyps are frequent health problems that can affect the quality of life.
Therefore, the correct and timely diagnosis as well as their appropriate treatment becomes very important.
But what are the risk factors, how will we recognize the symptoms, what are the problems and complications caused by gallstones, explains Mr. Themistoklis Feretis, MD, PhD, General Surgeon, Curator of the 1st Endoscopic Surgery Clinic, Metropolitan General, pointing out the therapeutic value of cholecystectomy in the treatment of gallbladder problems.
Are there any risk factors for gallstones?
The interaction between hereditary and acquired factors determines to some extent the predisposition to gallstone formation. More specifically, obesity, diabetes mellitus, female gender, pregnancy and sudden weight loss are considered important risk factors not only for the occurrence of gallstones but more specifically for symptomatic disease, due to the occurrence of complications. Foods rich in fat and a sedentary lifestyle are other predisposing factors. Recent studies show that physical exercise and a diet rich in fiber protect to a significant extent against the formation of stones.
What problems can gallstones cause and how will we perceive them?
The presence of stones within the gallbladder organ is sometimes asymptomatic and is discovered incidentally during a routine ultrasound examination. But more often it will cause symptoms less or more intense. The most common symptom is the sudden onset of severe pain in the upper abdomen that is usually temporally associated with eating fatty meals and may radiate to the back and be accompanied by fever.
Other times, a postprandial heaviness or bloating in the abdomen is simply reported, which is usually interpreted by the patients themselves as being of gastric origin.
The above symptoms are due to the strong contraction of the gallbladder and the subsequent colic induction and is possibly the mildest and usually self-limiting among the complications of cholelithiasis.
It is quite common to cause inflammation in the wall of the organ, i.e. cholecystitis. In this case, the pain lasts longer, is perhaps less intense compared to colic, is sometimes accompanied by fever or febrile movements, and often leads to the need for hospitalization for its treatment. Of course, it is understood that inflammations of the gallbladder can be multiple and recurrent.
Less common but much more serious complications of the condition are the inflammation of the pancreas (pancreatitis) or the creation of a serious infection in the biliary tree (cholangitis). In these cases, intense and long-lasting pain in the middle of the abdomen (especially in the case of cholangitis) and high fever with chills are characteristic symptoms. The two cases above can lead to long-term and serious health problems or even death if not treated immediately.
Treatment of gallstones and its complications
“The treatment of the above situations differs from case to case. We should separate the finding of gallstones as an incidental finding, from the occurrence of complications. In the event of an accidental finding, the patient should contact the surgeon in order to be evaluated and, depending on the indications, scheduled for surgery, while in the event of complications, the treatment is initially conservative, usually with admission to the clinic, depending on with gravity, which varies.
The definitive solution to benign diseases of the gallbladder is surgical removal of the organ, and more specifically laparoscopic cholecystectomy,” explains the doctor.
This specific approach is a minimally invasive surgical method that allows, due to the minimization of post-operative pain, the immediate return of the patient to his activities while making the operation also suitable for high-risk patients (elderly and/or with serious health problems). The gallbladder is not a vital organ and therefore can be removed without consequences for the human body.
The operation is performed under general anesthesia while access to the surgical field is made through 4 very small holes in different parts of the abdomen from which the optical camera and laparoscopic instruments are inserted, while the gallbladder is removed from the same points. Consequently, the operation also has an excellent aesthetic result since large scars are avoided.
The patient is admitted to the clinic early in the morning of the day of surgery, fed in the afternoon of the same day and returns home the next morning, being fully functional.
Finally, laparoscopic cholecystectomy can also be recommended as a treatment for symptomatic cholelithiasis in pregnant women, ideally during the second semester of pregnancy.
What are gallbladder polyps and when should they be treated?
The more appropriate term “polypoid lesions” of the gallbladder includes various lesions that are vastly benign and affect 5% of the general population. The main reason that makes this finding important is the connection with gallbladder cancer, which is one of the deadliest malignancies in the human body.
The reason for this unfavorable prognosis is that when symptoms appear, usually the disease has progressed to an irreversible stage. It therefore becomes vital to identify and focus on that very low, as mentioned above, percentage of polyps that may be harboring cancer cells, as in these few, presymptomatic patients simply removing the gallbladder and by extension the lesion, it will be largely therapeutic.
“The characteristic of polyps that more than any other has been linked to the likelihood of developing malignancy is size. Polyps larger than 1cm have an increased chance of metastasizing and are therefore an indication for cholecystectomy. For the smallest lesions, the patient is put on a follow-up protocol.
Regarding the treatment of polyps, laparoscopic cholecystectomy, as in the case of cholelithiasis, is the definitive solution to the problem”, concludes Mr. Feretis.
Written by:
Themistocles Feretis, MD, PhD, General Surgeon,
Curator 1st Endoscopic Surgery Clinic, Metropolitan General
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