Surgery is steadily losing its frightening image thanks to closed techniques that have been increasingly used in recent years. Especially in operations such as gallbladder removal, appendicitis and hernia repair, these procedures, which shorten the time to return to daily life and are performed through minimal incisions, have better outcomes than open surgery; their risk is lower than that of open surgery…
How do gallstones form?
Bile is produced by the liver, stored and concentrated in the gallbladder, and released through the common bile duct into the duodenum. Here it mixes with food to aid the digestion of fats. Imbalances in the chemical composition of the bile in the gallbladder lead to the formation of gallstones. Certain risk factors also exist, such as being female, being over 40 years of age, being overweight, having a family history of these diseases, high cholesterol levels, and blood diseases such as hereditary spherocytosis. Foods have no direct role in stone formation. 80% of gallstones are cholesterol stones. Nevertheless, a high-fat diet should still be avoided. Particularly after fatty, egg-based and fried meals, they can cause complaints such as indigestion, bloating, nausea, and pain in the upper right abdomen and back, especially spreading between the shoulder blades.
Is treatment with medication possible? Or is surgery the only option?
For gallstones that cause symptoms, the treatment is surgical. If they are not operated on, stones may pass out of the gallbladder and block the main bile duct, leading to jaundice. Sometimes they can cause inflammation of the pancreas called acute pancreatitis. Slightly larger stones block the outlet of the gallbladder, causing it to swell and become inflamed, which may require emergency surgery. Gallstones are a disease of the gallbladder. If only the stones are removed, the same stones will form again after some time. Also, we can continue our normal lives without a gallbladder. For this reason, there is no treatment that involves only removing the stones from the gallbladder. The gallbladder and the stones are removed together. Today, the most suitable surgical method for gallbladder stones is the laparoscopic approach. In laparoscopic gallbladder surgery, normally 3-4 holes of 0.5-1 cm in diameter were made in the abdominal wall. However, SILS ("single incision laparoscopic surgery"), first performed in the world in 2007, involves surgery through a single incision of approximately 1.5-2 cm at the navel. Through this single opening, specially designed instruments with angled tips that can bend are introduced into the abdomen. In addition, to facilitate the procedure, the gallbladder may sometimes be suspended from the abdominal wall with a suture. Thus, this technique can easily be applied to gallbladder conditions with normal anatomy that are not complicated. In recent times, robotic laparoscopic surgeries have also come into use for some diseases.
Is this method reliable?
With advancing technology and growing surgeon experience, laparoscopic surgeries are on the way to becoming the gold standard for many operations. Along with the reliability and feasibility of the technique, advantages include less pain after surgery and an earlier return to daily life. Single-incision laparoscopic surgery is a newly emerging method. Nevertheless, many operations such as cholecystectomy, adrenalectomy, laparoscopic total extraperitoneal inguinal hernia repair, right hemicolectomy, left hemicolectomy, rectal surgeries, sleeve gastrectomy, gastrojejunostomy, digestive system surgeries and nephrectomy have been performed through a single incision and reported in the world literature
What are the differences between open and closed surgeries?
What is done inside the abdomen is essentially no different between the two methods. The gallbladder is detached from its connections and removed. The difference lies in the procedure on the abdominal wall. In open surgery, a relatively large incision is made in the abdominal wall. A longer hospital stay is needed after surgery. Recovery takes longer. Return to daily life takes more time, and a large scar remains. In laparoscopic methods, surgery is performed through 3-4 holes of 0.5-1 cm length in the abdominal wall.
In the SILS method, surgery is performed through a single incision of approximately 1.5-2 cm inside the navel. Therefore, the laparoscopic method is superior to open surgery in terms of aesthetics. A shorter hospital stay is needed. Early return to daily life is possible. Pain after surgery is less.
Last updated: 18.12.2014.
