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CHOLELITHIASIS – GALLSTONES

UNDERSTANDING THE PROBLEM

The gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. The gallbladder holds a digestive fluid called bile that's released into the small intestine.

Cholelithiasis, commonly known as Gallstones are small, hard crystalline masses formed abnormally in the gall bladder or bile ducts from bile pigments, cholesterol, and calcium salts.

  • Cholesterol gallstones. The most common type of gallstone often appears yellow in color. These gallstones are composed mainly of undissolved cholesterol, but may contain other components.
  • Pigment gallstones. These dark brown or black stones form when your bile contains too much bilirubin.

Gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

Gallstones can cause severe pain and blockage of the bile duct.

UNDERSTANDING WHO SUFFERS

Gallstones are more common in women, Native Americans, Hispanics, people over age 40 and more prevalent in people who are overweight.

The following factors may increase the chance of developing gallstones

  • Obesity: is one of the biggest risk factors. Obesity can raise cholesterol levels and also make it harder for the gallbladder to empty completely. Bile can be part of the problem. Your body needs bile, but if it has too much cholesterol in it, that makes gallstones more likely
  • Diet including high fat, cholesterol and low fiber,
  • Gallbladder Malfunction; for example not emptying properly
  • Hormone Medication: Birth control pills, hormone replacement therapy for menopause symptoms, or pregnancy. The extra oestrogen is the problem. It can increase cholesterol and make it harder for the gallbladder to empty.
  • Diabetes. People with this condition tend to have higher levels of triglycerides (a type of blood fat), which is a risk factor for gallstones.
  • Rapid weight loss: stimulates liver to make extra cholesterol, which may lead to gallstones.
  • Genetic factors: Gallstones are also more likely if they run in your family, and they're likelier among women, older people, and some ethnic groups, including Native Americans and Mexican-Americans.
  • Cholesterol lowering medication: some of these drugs boost the amount of cholesterol in bile, which may increase your chances of getting cholesterol stones.
  • Other medical conditions: Pigment stones are more common in people with certain medical conditions, such as cirrhosis (a liver disease) or blood diseases such as sickle cell anaemia.
POTENTIAL SIGNS AND SYMPTOMS

Gallstones may cause no signs or symptoms. If a gallstone lodges in a duct and causes a blockage, signs and symptoms may result, such as:

  • Severe abdominal pain
  • Sudden and rapidly intensifying pain in the upper right portion of the abdomen or in the center of it, just below the breastbone.
  • Back pain between the shoulder blades
  • Pain that may extend beneath the right shoulder blade or to the back
  • Gallstone pain may last several minutes to a few hours.
  • Other digestive problems, including bloating, indigestion and heartburn, and gas
  • Pain that worsens after eating a meal, particularly fatty or greasy foods
  • Pain that feels dull, sharp, or crampy
  • Pain that increases when you breathe in deeply
  • Chest pain (angina)
  • A feeling of fullness in the abdomen
  • Vomiting, nausea, fever
  • Tenderness in the abdomen, particularly the right upper quadrant
  • Stools of an unusual color (often lighter, like clay)

For more serious gallstone complications, signs and symptoms could include:

  • Abdominal pain so intense that can't sit still or find a comfortable position
  • Yellowing of the skin and the whites of the eyes
  • High fever with chills
EXAMINATIONS USUALLY REQUIRED

Apart from a physical exam, the following tests are used to detect gallstones or gallbladder inflammation:

  • Blood tests to check for signs of infection or obstruction, and to rule out other conditions (Bilirubin, Liver function tests, Pancreatic enzymes)
  • Ultrasound. This quick procedure is done in the doctor’s office, and it makes images of the inside of the body.
  • CT scan. Specialized X-rays allow the doctor to see inside the body, including the gallbladder.
  • Magnetic resonance cholangiopancreatography (MRCP). This test uses a magnetic field and pulses of radio-wave energy to make pictures of the inside of the body, including the liver and the gallbladder.
  • Cholescintigraphy (HIDA scan). This test can check on whether the gallbladder squeezes correctly. Doctors inject a harmless radioactive material, which makes its way to the organ. The technician can then watch its movement.
  • Endoscopic ultrasound. This test combines ultrasound and endoscopy to look for gallstones.
  • Endoscopic retrograde cholangiopancreatography (ERCP). An endoscope is inserted through the mouth down to the small intestine and injects a dye to allow the bile ducts to be seen. Doctors can often then remove any gallstones that have moved into the ducts.
PROPOSING TREATMENT AND WHY AIMIS

Surgery for Gallbladder and Biliary Tract Disorders

If your doctor recommends surgery for a disorder, you may be a candidate for a minimally invasive approach - da Vinci Surgery.

AIMIS is an expert in Robotic Surgery for Robotic Assisted Cholecystectomy, Choledochotomy, Cholecystostomy and other minimal invasive procedures for the Gallbladder and Biliary Tract involving the best American and International surgeons who are experts in the field including:

  • Cholelithiasis – Gallstones - Cholecystectomy (Gallbladder removal), Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Cholecystitis - Gallbladder Inflammation - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Gallbladder Problems (Obstruction, Hydrops, Perforation, Fitsula) - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Bile Duct Problems (Obstruction, Hydrops, Perforation, Fistula) - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent
  • Cholangitis -Inflammation/bacterial infection of the biliary tract - Cholecystectomy, Hepatico-Jejunostomy, Choledochotomy, Cholecystostomy, Intraoperative Cholangiography, Transduodenal Papillosphincterotomy and Plastic Stent

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for gallbladder and biliary tract and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Virtually scarless surgery
  • High patient satisfaction
  • Minimal pain

To see the procedures we undertake with Robotic Xi Surgery, please click here

GETTING MORE INFORMATION BEFORE MOVING FORWARD
YOU MAY HAVE QUESTIONS LIKE:
  • Can I get more information before I commit to this?
  • Can I get a second opinion from you before I commit to this?
  • How can I find out the cost before I have any obligation?
WHAT AIMIS CAN DO:

AIMIS will provide a full review, diagnosis and potential surgical options for your condition, after receiving the relevant examinations and information from you. They will also provide an estimate for your surgical procedure before you decide.

AIMIS’ mission is to the provision of “true” healthcare for those who require it. It provides world leading surgeons using state of the art procedures to optimize potential surgical outcomes, whilst taking care of all arrangements so as to allow concentration on recovery.

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AFFORDABILITY

AIMIS provide competitive prices for state of the art procedures. We also work with a large range of Insurance companies where your policy allows you to have surgery abroad.

 

FURTHER INFORMATION ON THE PROBLEM:

Complications of gallstones may include:

  • Inflammation of the gallbladder (cholecystitis). Cholecystitis can cause severe pain and fever.
  • Blockage of the common bile duct. Gallstones can block the tubes (ducts) through which bile flows from the gallbladder or liver to the small intestine.
  • Blockage of the pancreatic duct. A gallstone can cause a blockage in the pancreatic duct, which can lead to inflammation of the pancreas (pancreatitis). Pancreatitis causes intense, constant abdominal pain and usually requires hospitalization.
  • Gallbladder cancer. People with a history of gallstones have an increased risk of gallbladder cancer. But gallbladder cancer is very rare, so even though the risk of cancer is elevated, the likelihood of gallbladder cancer is still very small.
FURTHER INFORMATION ON INCREASED RISK GROUPS
  • Diseases like cirrhosis, chronic hemolysis and ileal Crohn's disease are risk factors for black pigment stones.
  • Gallstone disease in childhood, once considered rare, has become increasingly recognized with similar risk factors as those in adults, particularly obesity.
  • Gallbladder cancer is uncommon in developed countries. In the U.S., it accounts for only ~ 5,000 cases per year. Elsewhere, high incidence rates occur in North and South American Indians.
  • Other than ethnicity and female gender, additional risk factors for gallbladder cancer include cholelithiasis, advancing age, chronic inflammatory conditions affecting the gallbladder, congenital biliary abnormalities, and diagnostic confusion over gallbladder polyps.
FURTHER EXAMINATION THAT MAYBE REQUIRED OR REQUESTED

If Bile duct blockage is suspected, in order to diagnose the cause the following test is ordered:

  • Percutaneous transhepatic cholangiogram (PTCA). A percutaneous transhepatic cholangiogram (PTCA) is an x-ray of the bile ducts. These are the tubes that carry bile from the liver to the gallbladder and small intestine. Bile is a liquid released by the liver. It contains cholesterol, bile salts, and waste products. Bile salts help the body break down (digest) fats. A blockage of the bile duct can lead to jaundice (yellow discoloration of the skin), itching of the skin, or infection of the liver, gallbladder or pancreas. When it is performed, PTCA is most often the first part of a two-step process to relieve or treat a blockage.
  • The PTCA makes a "roadmap" of the bile ducts, which can be used to plan the treatment.
  • After the roadmap is done, the blockage can be treated by either placing a stent or a thin tube called a drain.
  • The drain or stent will help the body get rid of the bile from the body. That process is called Percutaneous Biliary Drainage (PTBD).
WHY AIMIS FOR THIS SURGERY

AIMIS is an expert in Robotic Surgery for Robotic Assisted Cholecystectomy, Choledochotomy, Cholecystostomy and other minimal invasive procedures for the Gallbladder and Biliary Tract involving the best American and International surgeons who are experts in the field In contrast to other gallbladder-preserving minimally invasive or interventional methods, robotic is a one-session procedure avoiding the need for post-operative drainage of the gallbladder by a balloon catheter. Robotic cholecystectomy does not cause functional disturbances or severe bile duct injury, as is observed after cholecystectomy.

Da Vinci Surgery uses state-of-the-art technology to assist doctors in performing a range of delicate operations for gallbladder and biliary tract and offers several potential benefits over traditional open and laparoscopic surgery, including:

  • Low rate of major complications
  • Low conversion rate to open surgery
  • Virtually scarless surgery
  • High patient satisfaction
  • Minimal pain

Cholecystectomy through the belly button can be done using traditional single incision laparoscopy or da Vinci® Single-Site® Surgery. The da Vinci System features a magnified 3D high-definition vision system and flexible Single-Site instruments. These features enable your doctor to operate with enhanced vision and precision.

OTHER SERVICES PROVIDED BY AIMIS

In addition to its Innovative Healthcare, AIMIS provides seamless service along the way. From the start of your journey you'll know the best flights to take, where you'll be staying, what paperwork you will need. You will have a personal assistant assigned; from your pick up at the airport, to your accommodation, continuous assistance at your pre-consultation, through surgery and in your postsurgical care. Our Patients have said that they feel they have become "part of our family" and some even asked to stay a little longer! AIMIS is here to assist you in an all you requirements, allowing you to focus on your health and recovery.

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