How does keyhole surgery remove a gallbladder

Episode 7: Removal of the gallbladder : Small cuts, great relief

One and a half years of pain lie behind Jasmin Schumann (name changed). Every morning for eighteen months she woke up feeling sick and having stomach cramps. “It was a terrible time,” says the 61-year-old with the friendly, round face under her short, dark hair. "Getting up hurt, sitting hurt, breathing deeply hurt."

She could have been helped quickly with this. Your family doctor quickly had the correct suspicion: gallstones (see adjacent, enlargeable graphic). However, several ultrasound examinations with which these can be discovered did not provide any findings. The situation did not improve. Jasmin Schumann continued to suffer.

“At some point I noticed that the cramps always set in when I ate certain things,” she says. She couldn't stand fat, and neither did onions. The body immediately punished stone fruit and ice cream with cramps - again an indication of gallstones. The family doctor then sent Schumann to the hospital, where the more powerful ultrasound devices finally confirmed his first suspicions.

Now Jasmin Schumann is sitting in a yellow bathrobe on her sickbed in the DRK-Klinikum Köpenick. Her gall bladder and stones were removed three days ago. There are four small scars left and one great relief. She shines. "I feel like the wolf from a fairy tale after Little Red Riding Hood has been freed from her stomach," she says and laughs. Your things are already packed. She can leave the hospital in a few hours. The procedure went without any problems.

"The removal of the gallbladder is a standard operation," says Matthias Pross, head of the surgical department at the Köpenick Clinic. "In Berlin alone there are around 7000 events every year," he says on the way down the linoleum-tiled corridors to the operating room, where another patient is being prepared for a gallbladder removal. "70 percent of the problem affects women," says Pross. Doctors are not sure why, but female sex hormones and multiple pregnancies seem to increase the risk. Likewise, the hair color is blonde.

The patient in the operating room is prepared: the team of surgeons has made four three to ten millimeter long incisions in the abdominal wall. Through them the long-handled instruments and a camera are inserted into the body. "We operate in a minimally invasive manner," says Pross. So through the keyhole. To create space for the instruments inside, the belly is inflated with carbon dioxide like a balloon. Up to 30 liters of gas are required for such an operation.

Because of the small wounds, this type of procedure is considered to be gentler on the patient. In addition, most of them can go home after two to three days. In a classic procedure in which the abdomen was cut open, the hospital stay lasted around two weeks. The "keyhole surgery" has been the standard for gallbladder removal since 1991.

During the operation, the surgeon orientates himself on the camera images from inside the body, which flicker on monitors. There you can just see how the fatty tissue that has grown together with the yellowish gallbladder is being removed. "An indication that an inflammation has already occurred," says Pross. In the background, the liver glows dark red on the screens. Now the doctors cut the connection between the gallbladder and the bile duct. This is first tied off with two small clamps, then divided. It takes around 45 minutes for the gallbladder to completely loosen. The doctors finally pull out the pear-shaped organ, about the size of a fist, through a two-centimeter incision above the navel. Inside you will find a gray stone the size of a pigeon egg. He looks like he's been in the sea for a long time.

"Removing the entire gallbladder is the only way to get the stones under control and prevent new ones from forming," says Pross. Fifty years ago the gall bladder was cut open and only the stones removed. However, the sutures are always badly healed. Other treatment methods were also ruled out. “Ten or fifteen years ago, gallstones were sometimes destroyed with sound waves.” This often resulted in complications, as the small debris could clog the bile duct, which is why this method is hardly used any more. And cholesterol-lowering drugs would only be of prophylactic use for gallstones.

Nevertheless, surgery is not carried out immediately after a positive result. Because many people with gallstones do not experience any discomfort throughout their life. “This is why it is sometimes better to wait until the patient shows the first signs of problems before having an operation,” says Pross.

Jasmin Schumann is happy that her problems are behind her. In six days the strings will be pulled. But she doesn't have to go back to the clinic for this, her family doctor can do it. Is she happy to be able to eat what she wants again? “Yes, of course.” But she doesn't want to go overboard. Actually, she only dreams of a large plate of chicken soup, she admits.

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