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The wonders of modern gallstone removal technique.

More than 20 million people in the United States have gallstones, and approximately 1 million new cases are diagnosed annually. Gallstones are the most common -- and because of hopspitalization -- the most costly digestive disease, with an estimated overall yearly cost of more than $5 billion.

In humans, gallstones form when the bile that ordinarily acts to break down dietary fats accumulates and crystallizes around bacteria or other particles in teh gallbladder. Gallstones occur most often in the form of stoness composed of cholesterol or as pigment stones composed mainly of bilirubin and other compounds.

Most patients with gallstones remain asymptomatic for many years and may never develop the fever, jaundice, and abdominal pain characteristic of the disorder. However, once sympotoms appear, they tend to recur and these patients are prone to complications. Patients with symptomatic gallstones should be treated.

Gallstones are moe prevalent in women who have had multiple pregnancies, are obese, or who have experienced rapid weight loss as well as among older patients and certain ethnic groups.

Up until 1991, traditional open cholecystectomy-surgical removal of the gallbladder--was the most commom method of treatment for symptomatic gallstones. Removal of the gallbladder, which ordinarily acts as a reservior for bile, does not interfere with the normal digestive process.

After the gallbladder is removed, the bile manufactured by the liver flows to the intestine. Recovery from the traditional open cholecystectomy involves a 5-day hospital stay and a 3- to 6-week period of convalescence. A new procedure -- laparoscopic cholecystectomy -- diminishes postoperative pain, shortens the hospital stay and associated costs, and decreases scarring.

First performed in France in 1987 and in the United States in 1988, laparoscopic cholecystectomy requires the insertion, through tiny incisions into the patient's abdomen, of a fiber optic instrument attached to a tiny magnifying video camera and several specialized instruments.

After inflating the abdomen with carbon dioxide to separate the abdominal muscles from the internal organs, the surgeon inserts the laparoscopic instruments through multiple small incisions for visualization, manipulation, and dissection. The identification, isolation, and division of the cystic duct and artery and the subsequent removal of the gallbladder from its attachment ot the liver require meticulous surgical skill.

An estimated 15,000 surgeons have received some training in laparoscopic cholecystectomy techniques. Consumer demand for this form of surgery has escalated to the point where approximatley 80 percent of cholecystectomies are being performed in this manner.

With few exceptions, most cases of sumptomatic gallstones can be treated laparoscopically. patients who are usually not candidates for laparoscopic cholecystectomy include those with generalized peritonitis, septic shock from cholangitis, severe acute pancreatitis, end stage cirrhosis of the liver, and gallbladder cancer. Additional, pregnant women in their third trimester should also avoid undergoing laparoscopic cholecystectomy because of risk of damage to the uterus during the operation.

Because laparoscopic cholecystectomy is a relatively new surgery, experts noted that every effort must be made during this initial learning phase to ensure that doctors performing the operation are properly trained. Those endorsing the development of stringent guidelines also stressed the need for future research not only to develop equipment and refine techniques but to find a single noninvasive procedure to eliminate existing stones and to prevent stone recurrence.
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Publication:Nutrition Health Review
Date:Jan 1, 1993
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