The gallbladder is a small organ located in the right upper abdomen under the liver. When healthy, it stores some of the bile that is made by the liver. Bile is necessary to digest and absorb the fats in the food that we eat. When there is an imbalance in the chemicals in the bile, gallstones can form.
Patients with gallstones, called cholelithiasis, may experience intermittent right upper abdominal pain. The pain typically starts after a meal, and may be associated with nausea, vomiting or bloating. Fever may or may not be present. If a gallstone travels down the bile duct, you could have liver dysfunction or inflammation in the pancreas, called pancreatitis.
To determine if you have gallstones, the doctors at Mount Sinai will likely schedule an ultrasound of your abdomen. An ultrasound is a relatively quick and painless test, and can detect gallstones and evaluate the bile ducts using sound waves. If there are abnormalities in the pancreas or the bile ducts, additional imaging tests including CAT scan or magnetic resonance cholangiopancreatography (MRCP), may be necessary. Blood tests can also be helpful if infection or bile duct blockage is suspected.
Patients who have gallstones should eat a low fat diet. This will not get rid of the gallstones but will help to decrease your symptoms. There is no medication or medical treatment that has proven to effectively dissolve gallstones.
In people who have gallstones and symptoms, it is usually recommended that your gallbladder, with all of the stones, be removed. The gallbladder is not a vital organ and absorption and digestion can continue normally after it is removed. The gallbladder can usually be removed laparscopically, through small incisions.
If you have gallstones and don’t remove your gallbladder, you can risk infection of the gallbladder (cholecystitis) or bile duct obstruction leading to pancreatitis.
The minimally invasive laparoscopic surgical option for removing the gallbladder has become the standard of care at Mount Sinai. Once the decision has been made to proceed with cholecystectomy because of gallstone disease, four small (5-10 mm) incisions are made through which the laparoscope and surgical instruments are inserted. The diseased gallbladder and the stones within it are then removed through one of the incisions.
The benefits of the laparoscopic technique for gallbladder surgery include:
- Less post-surgical pain and need for pain medicine
- Shorter hospital stays (typically same day or 1-2 day stay) and faster recovery times
- Fewer post operative small bowel obstructions
- Fewer wound infections
Laparoscopic cholecystectomy is a very safe operation. The overall complication rate is less than 2 percent. In a small number of patients (less than 5 percent), if excessive scarring is present or the anatomy of the structures is not clear, the surgeon may decide to convert the operation to an open surgical operation through a traditional surgical incision.
The pancreas is a complex organ in the mid-abdomen that is involved in many body functions, including blood sugar regulation, and digestion and absorption of food. There are many different types of masses, or tumors, which can arise within the pancreas. Some tumors can be malignant, such as adenocarcinoma of the pancreas, and some can be benign, such a cysts. The prognosis and treatment of a pancreatic tumor depends on its location, its size, and the type of cells it arises from.
Pancreatic tumors can be evaluated closely on imaging studies, such a CT scan, in order to get information about its location and size. A biopsy is often needed to characterize the exact type of tumor, after evaluating the cells under a microscope. Since treatment of pancreatic tumors varies widely on the tumor characteristics, it is important to get an immediate evaluation by a specialist at a center that is experienced in treating these tumors.
The most common type of cancer of the pancreas is adenocarcinoma, which is an aggressive cancer that arises from the cells of the pancreatic duct of the pancreas. If a pancreatic cancer is surgically removable, it is ideal to have surgery as soon as possible before the tumor grows or metastasizes. A surgeon can discuss specific surgical options for these types of tumors. If a tumor is too far advanced, sometimes surgery is not a first-line option.
Patients with pancreatic cancer will also need to consult with an oncologist, as most patients will require chemotherapy and radiation therapy after or instead of surgery.
For pancreatic tumors that are not cancer, surgery can be curative. It is important to consult with a pancreatic surgical specialist immediately after diagnosis.
Laparoscopic Common Bile Duct Exploration
The physicians at Mount Sinai offer minimally invasive laparoscopic surgical options for common bile duct exploration or stone extraction. This is typically performed as an alternative to an endoscopic retrieval of obstructing gallstones prior to gallbladder surgery, when there is a high suspicion of common bile duct stones, or during laparoscopic gallbladder surgeries when common duct stones are detected. Typically, only 1-2 additional small incisions are required to perform this procedure when performed in conjunction with laparoscopic cholecystectomy.
Division of General Surgery
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New York, NY 10029