Essay Example on Gallbladder Disorders: Prevalence & Diagnosing With Ultrasonography

Introduction

The disorders associated with the gallbladder are prevalent and expensive in the US. The appropriate epidemiological diagnosing technique to correctly ascertain the exact area of the prevalence of gallstone illness is ultrasonography (Stinton and Eldon 172). Gallstones creates a great health concern in industrialized communities affecting 10-15 percent of the adult demographic, which means that 20-30 million Americans have or will experience gallstones problem (Stinton and Eldon 173). The primary predisposing factors of cholesterol gallstone development are not based on ethnic setting, female gender, family history or genetics, and advancement in age. However, the modifiable risk for cholesterol gallstones is a sedentary lifestyle, obesity, and rapid weight loss. In the United States, more than 1.3 million cholecystectomies are done each year (Jones and Deppen n.p). Before 1991, an open Cholecystectomy method was the standard procedure. It usually involved conducting an intraoperative cholangiogram, and patients were subjected to a 2 to 6-day postoperative in-house rehabilitation (Jones and Deppen n.p). Following development of laparoscopic surgery and the laparoscopic cholecystectomy in the early 1990s, the was a 32 percent increase in the entire performance of successful gallbladder surgeries. Currently, the American Medical Association boasts over 93 percent of all cholecystectomies are done laparoscopically (Jones and Deppen n.p). Though, the cholecystectomy procedures, however, advanced luckily seems to have stabilized the gallbladder illness in the late 1990s, and may even be on the decline in the U.S. The report will examine open cholecystectomy as the most regularly preferred abdominal surgery done in the U.S., with over 800,000 surgical procedures being done every year.

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Considerations

Indications

The signs for cholecystectomy are usually associated with symptomatic gallstones or complications related to gallstones (Hope and Roberts n.p). The most regular of these indications are the following; biliary colic, cholecystitis, choledocholithiasis, and biliary pancreatitis. Prophylactic cholecystectomy at the phase of a splenorenal shunt has been suggested on the grounds of the severe pain syndrome that the majority of the patients can result to open cholecystectomy (Hope and Roberts n.p).

With the growth of laparoscopic cholecystectomies, the sigs to perform an open cholecystectomy have declined (Jones and Deppen n.p). The most evident instance (2-10 percent) that an open cholecystectomy is done when converting from a laparoscopic to open cholecystectomy (Jones and Deppen n.p). This alteration is done for a myriad of reasons. Any moment there is a query on the overall anatomy, surgeons may result in an open surgical technique. Prolonged inflammation, adhesions, bile duct injury, uncontrolled bleeding, and anatomical variances are all indications that would warrant the performance of open cholecystectomy. The requirement for a bile duct exploration can also be a factor that would necessitate the change from a laparoscopic procedure to an open one since a laparoscopic bile duct examining can be hard (Jones and Deppen n.p). A planned open cholecystectomy can be performed in cases of gallbladder cancer, other comorbid disorders, cirrhosis, and extensive upper abdominal surgical procedures with adhesions. Critically ill patients may also need to open cholecystectomy as it is less complex, since the physiologic changes linked to a surgical pneumoperitoneum like a decreased cardiac return, and higher ventilation are not seen as alarming factors (Jones and Deppen n.p). Unclear visualization and poor anatomy structures are normally the reasons to result in an open cholecystectomy. The conversion to an open cholecystectomy should not be perceived as a complication, but the safest method to address any gallbladder disorders.

The moment oncology confirms gallbladder cancer in a patient, an open cholecystectomy should be done with close consultation from an expert hepatobiliary surgeon. In the case of chronic cirrhosis, and hemorrhage illness, resulting bleeding may be difficult to manage laparoscopically, therefore a percutaneous cholecystostomy tube may be the best method (Hope and Roberts n.p). Even though laparoscopic cholecystectomy has been regarded to be safe in cases of pregnant patients, an open surgical procedure must be used for pregnant patients primarily in their third trimesters, because laparoscopic port location and insufflation may be hard (Hope and Roberts n.p). Conversion rates for laparoscopic cholecystectomy differ greatly with a suggested choice of 1-25 percent (Hope and Roberts n.p).

Contraindications

Several research studies indicate that there are no contraindications in conducting an open cholecystectomy versus laparoscopic cholecystectomy. The ideal technique, however, is to finish the procedure using the laparoscopic method as this can be done to outpatients and decreases the recovery period from several weeks to about seven days (Jones and Deppen n.p). The overall contraindications for any surgical operations also apply to open cholecystectomy. In the case of laparotomy, the contraindications include chronic comorbid conditions like shock, severe cardiac, anticoagulation, recent neurologic event, and respiratory disease (Jones and Deppen n.p).

Frazee et al (491) argued that the relative contraindications for laparoscopic cholecystectomy as; acute cholecystitis, previous upper abdominal surgery, and melancholic obesity. An examination of 705 laparoscopic cholecystectomies conducted at several institutions was done to determine if these contraindications contributed to increased morbidity, an augmented rate of conversion to the open surgical method, or longer surgical time (Frazee et al 492). 196 patients showed one or more relative contraindications to laparoscopic cholecystectomy (Frazee et al 493). There were no reported cases of increased morbidity in patients with these risk factors, but the shift to open cholecystectomy was needed in a higher frequency of patients with acute cholecystitis. Complete contraindications for progressing with an open cholecystectomy are minimal, such relative contraindications are restricted to a chronic physiologic imbalance that hinders general anesthesia (Hope and Roberts n.p). In the instances of terminal disorders, temporary surgical operations like open cholecystectomy should be regarded in place of cholecystectomy.

Tests

Before a surgeon gives a clean bill for a gallbladder surgery several tests and evaluations should be done. These clinical assessments include; blood sample analysis, liver function tests, a urinalysis, and an abdominal scan (American College of Surgeons 2). The blood tests will include absolute blood count. Some of the advanced tests that should be done before surgery include; Hepatobiliary iminodiacetic acid scan (HIDA scan), Endoscopic retrograde cholangiopancreatography (ERCP), and Magnetic resonance (American College of Surgeons 2). After a surgeon gives you an approval for either an open cholecystectomy or laparoscopic cholecystectomy, several expectations should be followed like a patient should not eat for up to 5 hours, but may be allowed to drink pure fluids up to 2 hours before a surgical procedure (American College of Surgeons 4).

When conducting the diagnosis, a scan of the gallbladder, and abdominal, should be obtained, further "Hilda ultrasound" should also be done (Hope and Roberts n.p). The decision to conduct a planned open cholecystectomy needs to be made by the surgeon. However, a laparoscopic surgical procedure can always be shifted to an open procedure if the need arises. In such cases, the patient should be hemodynamically stabilized and resuscitated (Hope and Roberts n.p). Necessary permissions and data should be deliberated with the patient including all risks, benefits, and options. Normal pre-operative preparation like probable antibiotics, deep vein thrombosis prophylaxis should be examined (Hope and Roberts n.p).

Incisions

In the case of an open cholecystectomy, a right subcostal (Kocher) incision is the most commonly used surgical procedure as it permits for great exposure of the gallbladder bed and cystic duct (Jones and Deppen n.p). On the other hand, an upper midline incision can also be used when other related surgical processes are prearranged, and greater contact is required. Normally, the midline incision stands above the umbilicus, still permitting adequate exposure of the gallbladder with suitable withdrawal (Jones and Deppen n.p). A right paramedian incision is another alternative, however, it is not regularly used at present (Jones and Deppen n.p). When conducting an incision a surgeon should begin with the subcostal incision about 1 cm to the left of the linear alba, about two finger ranges beneath the coastal area (4cm). Spread the incision across for 10-15 cm, hellbent on the patient's body adaptation (Jones and Deppen n.p). A surgeon should then cut the anterior rectus covering along with the breadth of the incision and cut the rectus, and the lateral muscles with the electrocautery (Jones and Deppen n.p). Afterward, the surgeon should incise the subsequent rectus cover and peritoneum, and enter the abdomen (Theodosopoulos 101). The Kocher's opening technique for the right-sided gallbladder is precisely advantageous, benign, and involves a postoperative recovery (Theodosopoulos 101). Further, the use of Kocher's incision and other mini-incisions include its reduced cost, faster completion of the procedure, decreased bulkiness of the surgical devices and the probability of examining the general open cavity without loss of palpable sensation (Theodosopoulos 101). The Kocher incision category has a quicker hospital stay than the midline opening groups (Theodosopoulos 101). The main disadvantage or risk of this approach include incisional hernia that could put the patient on the risk of death. Open cholecystectomy incisions are more risky and painful than the laparoscopic surgical procedure. Bile leaks, and bile duct injury, and also unremoved bile duct stones are all risk factors associated with open cholecystectomy incision (Jones and Deppen n.p).

Other Considerations

This section will attempt to assess the health-associated post-surgical quality of life for patients following an open cholecystectomy procedure (Sadati et al. 1). There are numerous other elements, rather than the whole procedure that can have an impact on the value of life of patients operated for simple cholecystolithiasis (Sadati et al. 2). The factors impacting the quality of life can be categorized as physical, mental conditions, interpersonal relations, social conditions, clinical situations, and monetary structures. In a recent study done by Sadati et al. (2-3), ninety-five patients were registered for a program after undergoing an open cholecystectomy to assess their QOT. According to the results, postoperatively, the physical condition, psychological status, and body pain proportions of health were greatly enhanced (Sadati et al 4). There were greater enhancements in gastrointestinal quality of life index in the physical health, mental well-being, and gastrointestinal digestion improved.

Open reduction and internal fixation is a surgical operation done to patch-up a broken bone after a major surgery like an open cholecystectomy (Intermountain Healthcare 1). Open reduction implies the physician institutes a incision to make contact with the bones and realign them back into their normal position. Internal fixation states that metal screws, plates, rods are kept on the bone to keep it in tact while it heals (Intermountain Healthcare 1). The internal fixation will not be extracted. The instances when a surgeon may recommend an ORIF to the patient include when a bone is broken int...