Indications and Evaluation

Currently, the Centers for Disease Control and Prevention estimates 600,000 to 750,000 cholecystectomies are performed annually in the United States. Cholecystectomy is classically indicated to treat signs, symptoms, and complications of gallstones. Despite the relatively low risks associated with laparoscopic cholecystectomy, the procedure should be limited to symptomatic patients. These patients are at increased risk of developing complications including acute cholecystitis, common bile duct obstruction, cholangitis, and pancreatitis. Evidence exists that these complications seldom develop at initial presentation, so asymptomatic patients are generally treated with watchful waiting. Laparoscopic chole-cystectomy is also indicated for patients without gallstones but typical biliary colic. These patients may have acalculous cholecystitis or biliary dyskinesia diagnoses made by quantitative gallbladder emptying or radio-nucleotide study.

The quick recovery and excellent outcomes of laparo-scopic cholecystectomy have reduced the reluctance of patients to undergo gallbladder surgery, leading to an increase in the number of cholecystectomies performed annually. During the 1990s, there was a 29% increase in the number of cholecystectomies performed, with over a 100% increase in cholecystectomy for acute acalculous cholecystitis and 300% increase for biliary dyskinesia. Although nonsurgical methods of gallstone removal, including phar-macologic dissolution, shock wave lithotripsy, and endo-scopic laser ablation, were once considered alternatives to the traditional open surgical approach, widespread use of laparoscopic cholecystectomy with its increased patient acceptance, has generally lead to the elimination of these treatments as alternatives.

Despite advances in radiologic methods, ultrasono-graphy remains the mainstay of gallbladder imaging. information obtained from a right upper quadrant sono-gram (ie, including the presence of gallstones, gallbladder wall thickening, pericholecystic fluid, and common bile duct dilatation) surpasses other diagnostic studies at a fraction of the cost. Radioscintigraphy of the biliary tree has two indications. First, it confirms gallbladder uptake or cystic duct obstruction in the diagnosis of acute cholecystitis in patients with confounding symptoms, signs, and medical conditions. Second, a calculated gallbladder ejection fraction below 35% following administration of intravenous cholecystikinin during scintigraphy is used to diagnose biliary dyskinesia. In addition to radiologic tests, laboratory evaluations, including complete blood count, liver function tests, and serum amylase and lipase, help confirm disease processes and determine treatment plans.

The choice of surgical treatment may be affected by a patient's medical comorbidities and presentation. Severely limiting cardiac and pulmonary disease processes may prevent a patient from withstanding the rigors of even laparoscopic surgical intervention. Creation of a pneumoperitoneum leads to multiple cardiovascular effects including decreased stroke volume, cardiac output, and venous return. Patients also develop increased systemic and pulmonary vascular resistance, mean arterial pressure, central venous pressure, and pulmonary artery wedge pressure. Most of these effects are directly related to the mechanical effects of increased intra-abdominal pressure, but sympathetic stimulation and biochemical effects of the gas used to create the pneumoperitoneum add to the insult.

Early in its development, some surgeons limited the use of laparoscopic approach, avoiding patients with acute cholecystitis, gallstone pancreatitis, choledocholithiasis, hepatitis or cirrhosis with portal hypertension, previous abdominal surgery, severe obesity, sepsis, and pregnancy. As surgeons have surpassed the "learning curve," the relative contraindications to the laparoscopic approach have been reduced or eliminated. In fact, preoperative concern for gallbladder carcinoma remains the only absolute contraindication to laparoscopic cholecystectomy because of the risk of dissemination of cancer cells by the turbulent flow of gas in the pneumoperitoneum.

Get Rid of Gallstones Naturally

Get Rid of Gallstones Naturally

One of the main home remedies that you need to follow to prevent gallstones is a healthy lifestyle. You need to maintain a healthy body weight to prevent gallstones. The following are the best home remedies that will help you to treat and prevent gallstones.

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