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CHOLECYSTITIS
* Hendro Wartatmo
Department of Surgery
Sub Division of Digestive Surgery
Terminology :
Cholelithiasis : gall stone / bile stone / gall bladder stone
Cholecystitis : inflammation of the gall bladder
Cholecystotomy : removal of the gall stone by means of incision of the
gall blader and resuture it
Cholecystectomi : removal of the gall blader by means of surgery
Cholelithiasis & 2
Aetiology of Cholelithiasis
Confirmed aetiology : unclear
Predisposing / Suspected factors :
Triple Fs : Fourty, Fatty, Female
Bile viscosity
Nidus : clot of dead bacteria / detached epithelial cells
of gall blader
Genetic
Cholelithiasis & 3
Complications :
Hydrops of the gall bladder
Chronic Cholecystitis
Acute Cholecystitis :
Suppurative, Gangrenous, Perforated
Gall stone ileus
Cholelithiasis & 4
Diagnosis :
Clinical symptoms & Signs :
Dispepsia, Meteorism, Colicky pain, Tenderness over right subcostal
region : spontaneous / by pressure ( Murphys sign )
Mild Jaundice ( moderate : choledocolithiasis, deep : total
obstruction malignancy )
Fever, Leucocitosis Acute Cholecystitis
Imaging :
USG ( 95 % accuracy ) , CT Scan
Cholelithiasis & 5
Ultrasonography
Cholelithiasis & 6
Treatment :
Non operative :
Medication ( stone dissolver ) : < 3 cholesterol stones,
diam. < 0.5 cm, 8 tablets daily for two months ..
Boring, Reccurrent
Extracorporeal Short Wave Lithotryptor ( ESWL ) : < 3
cholesterol stones, diam. < 0.5 cm, patent cystic duct,
no inflammation of gall blader Recurrent stone
Only few cases fulfill the criteria and suitable for these
methode of treatment
Cholelithiasis & 7
Operative Treatments :
Cholecystotomy :
Removal of stones by means of incision and and
resuture it --- reccurrent, no longer used
Cholecystectomy :
Removal of the ( containing stone ) gall bladder
Open : by opening the abdominal wall
Laparascopic : by means of laparascopy surgery ( =
minimal invasive surgery )
Cholelithiasis & 8
Personal Data
Private Hospital, 2000 2001
Number of Surgery : 506
Choledocholithiasis : 8 cases
Cholelithiasis : 154 cases
Uncomplicated : 114
Open Surgery : 36
Laparascopy : 78
Complicated : 40
Open Surgery : 29
Laparascopy : 11
Cholelithiasis & 9
Open Cholecystectomy in
Suppurative Cholecystitis
Cholelithiasis & 10
Suppurative Cholecystitis
with Abscess in the
Abdominal wall
Cholelithiasis & 11
Suppurative
Cholecystitis
with Abscess in the
Abdominal wall
Cholelithiasis & 12
Koledokolithiasis
Stone CBD
Cholelithiasis & 13
Laparascopy Cholecystectomy
Cholelithiasis & 14
Cholelithiasis & 15
GasLess Laparascopy
Cholelithiasis & 16
Cholelithiasis & 17
After removal of Gall bladder :
Dyspepsia / malabsorbtion :
Gall blader : bile storage
Digestive proccess w.o gall bladder : direct flow of bile
from liver to duodenum
Adaption in several weeks
Resolved with time / adapttion
No dyspepsia when the gall bladder removed does
not function ( due to inflammation ) before
surgery.
Cholelithiasis & 18
Surgical Complications :
Cholecystectomy : tidy surgery
Many Anatomic variations
Injury of the biliary tract
Treatment :
Surgical repair
Cholelithiasis & 19
National Meeting of Indonesians Digetive Surgeon Ass., Manado 2003
Hendro. W
Department of Surgery
Sardjito General Hospital / Faculty of Medicine Gadjah Mada University,
YOGYAKARTA
Relaparatomie for complications of
Hepato-Pancreatico-Biliary Surgery
Series of personal cases : 1990 1995
TOTAL 21
( 19 referred patients + 2 own cases )
Case :
Hepaticojejunostomy R en Y for
CBD Injury during Simple Cholecytectomy
Male, 24 yr
Simple Cholecystectomy for Cholelithiasis with Acut cholecystitis 2
months before.
Pulmonary tuberculosis was suspected.
Icteric, distended abdomen, febris
Relaparotomy : 7500 cc of bile in abdominal cavity, CBD had been cut,
3 cm of CBD was missing.
Internal drainage : hepaticojejunostomy R en Y.
Complete recovery
Cholelithiasis & 22
Preoperative distended abdomen + Icteric + Sepsis
Iatrogenic Trauma
Cholelithiasis & 23
Knot 2 Proximal CBD
Cholelithiasis & 25
Tube Cholangiography in
Hepaticojejunostomy R en Y
Anastomosis
Efferent Loop
Stent
Day 14
Post Operative
Stent
Cholelithiasis & 27
THANK YOU