Why after 140 years, is the primary surgical treatment for gallstones to still just chop out the gallbladder?
The practice of completely cutting out the gallbladder to "cure" gallstones goes back to 1878 when it was first successfully performed, and which is nearly prehistoric times in medical history and technology.
Indian Journal of Surgery, Vol. 66, No. 2, Mar-Apr, 2004, pp. 97-100
Surgical history
Evolution of cholecystectomy: A tribute to Carl August Langenbuch www.bioline.org.br/request?is04023
Due to the rise of modern minimally invasive abdominal surgical procedures and use of robots like the Davinci for heart surgery, why hasn't this surgical practice been applied to remove gallstones and simply suture/glue the gallbladder closed again, so that the body can still use the organ?
The gallbladder is far simpler in function by comparison to the heart, yet the primary surgical choice is still the barbaric 1878 excise procedure.
Complete removal of the gallbladder leaves a person with a seriously dysfunctional digestive system that can no longer digest fats effectively. Too much fat (ingested as part of a normal meal for someone with a functioning gallbladder) will instead result in diarrhea as the undigested oils race through the gut, and potentially resulting in uncontrolled and embarrassing anal leakage, loose stools, and fecal odor.
Additionally for some patients, even after complete removal, abdominal pain never goes away but continues after the procedure for the rest of the life of the patient.
Is there really still no better surgical option available, to remove gallstones and leave the repaired, emptied gallbladder in place?
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I share your feelings about gallbladder removal being barbaric.
Here is some reasoning why most gallbladder conditions are treated by gallbladder removal.
Alternative treatments, such as gallstone dissolution with ursodeoxycholic acid is effective only for small gallstones (<0.5 cm); also, after discontinuation of treatment, the stones often reappear (Emedicine).
Making a cut in the gallbladder and removing gallstones is a major risk for a serious abdominal infection (peritonitis), which can occur even after gallbladder removal (PubMed). This is especially critical in acute gallbladder inflammation.
Chronic gallbladder inflammation can cause pain and gallbladder removal is pretty much the only known treatment (MedlinePlus).
To effectively treat gallbladder cancer, you typically need to remove some tissue around it (safe margin) and this is most reliably done by removing the gallbladder.
It is true that about 1/3 of people, after gallbladder removal, will have long-term problems with diarrhea, but this is due to irritation by large amounts of bile that constantly flows from the liver to the intestine and not due to fat maldigestion (Mayo Clinic). Many people will have no symptoms.
If the origin of pain is in the gallbladder, the pain should disappear after gallbladder removal. The pain that persists after the removal usually arises from the bile ducts that stay in the body, for example, due to stones in the bile ducts or sphincter of Oddi dysfunction.
In elderly or severely ill individuals, who are not fit enough to undergo gallbladder removal, drainage of the gallbladder can be performed as a palliative measure with a temporary effect (PubMed Health).
Simple answer. "Once a stone former, always a stone former"
"Gallstones recur in about 50% of patients, and that the risk of recurrence is confined mainly to the first 5 years after dissolution." Hence, we remove them
Source:
Management of recurrent gallstones.
Review article
Lanzini A, et al. Baillieres Clin Gastroenterol. 1992
www.ncbi.nlm.nih.gov/m/pubmed/1486214/
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