Dariusz Litera
Gallbladder diseases are an increasingly common health problem in Poland.
Gallstone disease, which involves the formation of deposits in the gallbladder, affects approximately 20%
population, with women being affected four times more often than men. The risk
the disease increases with age. You are over forty and you are afraid that you might have this
problem. Today your doctor is surgical specialist Dr. Adam Kuźmiński. Good morning,
Mr. Doctor.

Dr. Adam Kuźmiński
Good morning.

Dariusz Litera
What are the most common symptoms that indicate gallbladder problems such as gallstones?
or cholecystitis?

Dr. Adam Kuźmiński
The first thing patients come with is a pain attack. A pain attack that most often
It passes and only after some time does the patient come to the doctor. He treats it on his own.
Warm compresses, painkillers, antispasmodics—everything he has at home. And
then comes the reflection what happened to me?

Dariusz Litera
It's such a stabbing pain.

Dr. Adam Kuźmiński

It varies greatly. From stabbing pains, through dull aches, girdling pains, and aches.
pain. This is one of the elements we talk about when it comes to the symptoms of gallstones.
gallbladder. These may be symptoms related to indigestion, they may be symptoms such as bloating,
belching. There are many, many symptoms. These are things that
which we do not pay attention to at all and do not realize that they can be
associated with gallstones. And sometimes it looks like the patient has an ultrasound of the gallbladder
abdominal for a completely different reason. He finds out that he has gallbladder deposits.

Dariusz Litera
Well, what diagnostic tests need to be performed to definitively state that
that something is wrong with the gallbladder?

Dr. Adam Kuźmiński
As I mentioned, the basic test is an ultrasound. This is a test that
is widely available these days. It is a very safe test that
can be safely repeated. The test, which is dedicated to this type of disease,
to this type of organs, to the parenchymal organs, i.e. to the liver and to everything that is
related to the biliary tract. In such a test it is possible to determine with almost one hundred percent certainty whether
Does the patient have stones or deposits? A deposit is a stone, that's obvious. Does it have
polyps in the gallbladder, which is also very important. Do these stones not move into the urinary tract?
bile ducts, do they not block these bile ducts?

Dariusz Litera
If it turns out he is the owner, what happens then?

Dr. Adam Kuźmiński
Here, the treatment is typically surgical, although attempts can be made to dissolve these stones.
The selection of these methods is very difficult and difficult and unfortunately you have to rely on medical help here.
Surgical treatment is essential. Nowadays, the gold standard is
laparoscopic cholecystectomy, i.e. removal of the gallbladder using a laparoscope.
If this cannot be done using laparoscopy, then an open procedure is performed.

Dariusz Litera
So we open the abdominal cavity.

Dr. Adam Kuźmiński
We open the abdominal cavity.

Dariusz Litera
We extract the follicle and get rid of it.

Dr. Adam Kuźmiński
Exactly.

Dariusz Litera
Now I'll remind you about the methods from the "don't try it yourself at home" series. So I remember from
family stories that one of my father's brothers was diagnosed with some stones in his
the gallbladder received a recommendation from a healer to drink half a glass of oil.

Dr. Adam Kuźmiński
This is some idea for good diarrhea.

Dariusz Litera
It's unconfirmed that this had any positive effects, but such things have happened. It really has.
Please do not try such methods at home. It is better to ask a doctor before we go any further.
gallbladder removal. How severe do the symptoms have to be? What needs to happen?

Dr. Adam Kuźmiński
The ideal patient for cholecystectomy is one who has not had any inflammatory conditions,
and it already has symptoms. There was a time in the history of medicine when we operated on every stone that
was found in the gallbladder. Currently, the recommendations are slightly different. We do not operate on all
patients with deposits found in the gallbladder. Who do we operate on? Regarding the size
stones – small stones, i.e. up to 2-3 mm. We are very afraid of them because they are very easy to
pass into the bile ducts, blocking these bile ducts and may cause pancreatitis,
which may turn out to be a fatal condition for the patient. And we definitely operate on stones
large, above 2.5 - 3 centimeters. Here, in turn, there is an increased risk of cancer, because such
the stone causes pressure sores on this follicle, which may result in later years
the presence of bladder cancer, which we cannot really treat.

Dariusz Litera
So as soon as we detect something there, there is a surgical indication to get rid of it.
gallbladder?

Dr. Adam Kuźmiński
Well, not necessarily. Specifically, if we have a patient who doesn't have any pain, who doesn't have any
symptoms and during some random ultrasound examination it turns out that you have mainly
a stone the size of one centimeter, half a centimeter. We don't operate on such a patient because
there are no indications for this. Such a patient is under observation.

Dariusz Litera
Because this stone will not block our bile ducts.

Dr. Adam Kuźmiński
It won't block the bile ducts. On the other hand, we wait for the first symptom to appear,
must be symptomatic. And this raises the question, what is a symptom of gallstones? Does it have to be
there may be a pain incident, and the pain is really severe. Is it enough that these are symptoms of indigestion,
bloating after eating, some kind of crushing sensation, as patients describe it, girdling pains that patients
are not at all related to the presence of stones in the gallbladder. Here we have to think carefully and
it is good to ask such a patient, because if he has these types of symptoms, no pain but discomfort
in the abdominal cavity, this is also an indication for surgery.

Dariusz Litera
What are the potential complications after bladder removal surgery?

Dr. Adam Kuźmiński
Cholecystectomy, whether laparoscopic or open, is a procedure that is associated with
a very serious complication that can occur in surgery called respiratory disability
biliary, i.e. damage to the main bile duct. This is a complication that requires several
sometimes repair procedures. In most cases open. Very long stay
in the hospital is associated with a poor future prognosis for such a patient.

Dariusz Litera
But I understand that this is a small percentage.

Dr. Adam Kuźmiński
A very small percentage. We try to prepare very well for this type of procedure.
Therefore, each patient who signs consent for laparoscopic cholecystectomy has
there is always a clause that in certain situations he consents to the opening of the abdominal cavity. What
Are these certain situations? First, there are some major anatomical inaccuracies. They happen
patients who are built a little differently and we have trouble placing the tools. We have
problem with reaching this follicle.

Dariusz Litera
For example, they have dextrocardia.

Dr. Adam Kuźmiński
For example.

Dariusz Litera
Heart on the right side.

Dr. Adam Kuźmiński
This is not a contraindication, because the tools can be inserted in other ways. If we have
some uncontrolled bleeding during the procedure that we cannot, we cannot
closed using laparoscopic clips. If we have any doubts about
presence of a stone in the bile ducts, then we also open such a patient.

Dariusz Litera
So as not to leave any artifact that we could have removed.

Dr. Adam Kuźmiński
Yes Sir.

Dariusz Litera
Doctor, what's the diet like after gallbladder removal?

Dr. Adam Kuźmiński
Dieting is temporary. Dieting only serves to accustom our liver to the information
that there is no storage. That the production of bile that occurs must only be when we see,
We hear the clatter of plates, see the food, smell the dinner. Then my liver
produce this bile. Besides, probably not. There is no storage, so in such a case the patient
has for some time this liver training, may have diarrhea after cholecystectomy. This is
related to the movement of bile into the digestive tract itself.

Dariusz Litera
But can we stabilize it?

Dr. Adam Kuźmiński
A proper diet. There are two more things to remember when we get down to it.
diet. Patients should follow this diet very strictly before the procedure. Two foods,
which shrink the gallbladder the most are chocolate and eggs, so we should eat those
should be avoided in any form. When it comes to diet after the procedure, the basic rule is
Eating very small portions, quite often. It's like checking how I feel after eating.
something. The bile ducts after such a procedure remain the same width, and the amount of bile that must
to get through is two, three times, sometimes greater. Therefore, we can have
pain while eating is similar to that experienced before the procedure. This is not a reason to
anxiety. After some time, these bile ducts got used to this larger amount of bile,
which they need to transport to the digestive tract and the pain will disappear.

Dariusz Litera
And do we return to normal activity, including sports, relatively quickly after such a procedure?

Dr. Adam Kuźmiński
After laparoscopy, this happens very quickly. After 3-4 days, the patient is fully recovered.
strength. The procedure is not very burdensome for the patient in terms of his physical activity. Here
one thing that determines the stay in the hospital or the recovery period is the patient himself
anaesthesia process or general anaesthesia requiring a large amount of drugs and we have to
metabolize.

Dariusz Litera

Finally, one more important question: Can we, as conscious people, apply such
methods that will effectively prevent the formation of stones in the gallbladder?

Dr. Adam Kuźmiński
Yes. We need to remember a few things. We need to take care of our weight. Obesity is very conducive to
stones. On the other hand, sudden weight loss. Sudden diet, miracle diet also causes increased
risk of stone formation. We have a lot of patients who have started using, I won't use the name
commercial, because you are not allowed to use a certain slimming drug that causes the formation of stones
in the gallbladder. And there are many of these patients who have lost weight beautifully, but with the presence
deposits in the gallbladder.

Dariusz Litera
And this is the effect of this rapid weight loss. These deposits appear,
when the liver is…

Dr. Adam Kuźmiński
Impaired bile flow. When do stones form? When does the flow become impaired?
this yellow and when we have, when we have some kind of fire that will arise. And on this fire
is deposited like a pearl, bile is deposited, bile salts are deposited and a deposit is formed which
then it calcifies.

Dariusz Litera
So you also need to be smart about losing weight?

Dr. Adam Kuźmiński
Definitely!

Dariusz Litera
This was said in the podcast CO DOCTOR SAYS by a surgical specialist, Dr. Adam Kuźmiński.
Thank you very much.

Dr. Adam Kuźmiński
Thank you very much.