GallstonesFAISAL GHANI SIDDIQUI

MBBS; FCPS; PGD-BIOETHICS; MCPS –HPE

PROFESSOR OF SURGERY,IN CHARGE, MINIMAL INVASIVE SURGICAL CENTRE, &

& IN CHARGE, BIOETHICS PROGRAMME AT LIAQUAT UNIVERSITY OF MEDICAL & HEALTH SCIENCES

faisal@lumhs.edu.pkwww.lumhs/faculty/surgery

Preamble

• Why gall bladder?

• Surgical anatomy & physiology of gall bladder

• Why gallstones form?

• How do gallstones present?

• How to manage a patient with gallstones?

Functions of Gall Bladder

• Reservoir for bile

• Concentration of bile

• Secretion of mucus

Anatomy of

Gall Bladder

Fundus

Body

Neck

Infundibulum

Cystic duct

Bile Ducts

• Common hepatic

duct

• Cystic duct

• Common bile duct

Common Bile Duct

• Supraduodenal

• Retroduodenal

• Infraduodenal

• Intraduodenal

Calot’s

Trianglekah-lō′

Moynihan’s

Hump

Gallstones (Cholelithiasis)

Types of

Gallstones

• Cholesterol

• Pigment

• Mixed

Causes-Cholesterol Stones

• Supersaturated bile

–Obesity

–High caloric diet

–Oral contraceptives

–Resection of terminal ileum

Causes-Pigment Stones

• Hemolysis

–Hereditary spherocytosis

– Sickle cell disease

Causes-Mixed Stones

– Infected bile

– Foreign bodies in the CBD (stents, parasites e.g. Clonorchis sinensis)

Clinical Features

• Asymptomatic

• Pain

• Complications

Complications

• Acute cholecystitis

• Mucocele

• Empeyema

• Choledocholithiasis

• Acute pancreatitis

• Intestinal

obstruction

Treatment for Cholelithiasis

Treatment -Indications

• Symptomatic gallstones

• Complicated gallstones

• Silent gallstones

– Diabetics

– Patients undergoing bariatric surgery

Procedures

• Open cholecystectomy

• Laparoscopic cholecystectomy

Laparoscopic Cholecystectomy

• Supine/reversed Trendelenburg’s

• General anesthesia

• Preparation of abdomen / toweling

• Creation of pnemoperitoneum

– Closed technique (Veress’ needle)

– Open technique (Hassan’s)

• Additional ports