Gallstones

Laparoscopic (Keyhole) Cholecystectomy (gallbladder removal)
Laparoscopic cholecystectomy is the surgical removal of a diseased gallbladder using the keyhole approach.

Laparoscopic cholecystectomy does not require cutting of the abdominal muscles, resulting in less pain, quicker healing, improved cosmetic results, and fewer complications such as infection and adhesions.

Laparoscopic (keyhole) cholecystectomy has replaced the open (conventional) cholecystectomy and is now the gold standard treatment for gallstones and inflammation of the gallbladder.

Advanced Laparoscopic Surgery Wales (ALSW) specializes in the laparoscopic (keyhole) treatment of gallbladder diseases.

Ashraf Rasheed the director of ALSW is a lead laparoscopic (keyhole) surgeon, a specialist biliary (gallbladder) surgeon and an expert at laparoscopic clearance (exploration) and endoscopy (choledochoscopy) of biliary ducts.

Laparoscopic Common Bile Duct Clearance (LCBDC)
LCBDC is associated with a lesser risk of morbidity and mortality in the young (< 50 yr) and fit (ASA 1 & 2) patient compared with preoperative ERCP and subsequent laparoscopic cholecystectomy.

Urgent laparoscopic cholecystectomy (ULC) for acute cholecystitis
ULC (emergency admission laparoscopic cholecystectomy) avoids the risks of failure of conservative treatment (20%) and of relapse while awaiting surgery (20%), obviates the need for a second admission, reduces overall hospital stay and can be performed safely with minimal conversion rates (<1% with urgent surgery for 'all comers').

Day Case Laparoscopic Cholecystectomy
50% of elective laparoscopic cholecystectomy might be suitable to be performed on day-case basis

Gallstones



The Gallbladder
The gallbladder is a reservoir for bile. It receives dilute bile from the liver, stores and concentrates it during the inter-digestive period and evacuates the more viscous gallbladder bile in response to seeing, smelling or eating food. Bile enters and leaves the gallbladder via the cystic duct. Fatty food is a potent stimulus for gallbladder emptying. Conditions which slow or obstruct the flow of bile lead to gallbladder disease.

Gallstones
Gallstones formation represents failure to maintain biliary solutes (cholesterol, bile pigment, calcium salts, etc.) in solution. Gallstones develop due to excess of one or other biliary solutes (cholesterol, bile pigment) or due to stasis of bile within the gallbladder. Gallstones may obstruct the normal flow of bile if they lodge in any of the ducts that carry bile from the liver to the small intestine.

Risk Factors for Gallstone Formation
Age Increasing age
Body habitus Obesity/ Rapid weight loss
Childbearing Pregnancy
Drugs Fibrates/Contraceptives/ Postmenopausal Oestrogens/Octreotide
Ethnicity Scandinavians
Family Maternal family history of gallstones
Gender Females
Hyperalimentation Total parenteral nutrition / Fasting
Ileal and other metabolic diseases Ileal disease (Crohn's disease), Resection or Bypass / High Triglycerides, Diabetes Mellitus, Chronic Haemolysis