Gallstones: Symptomatic vs. Asymptomatic

[facetguy]

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In looking over some of the literature regarding gallstones, reference is usually made to symptomatic and asymptomatic patients. What about a patient who has only had 2 'attacks' over a several-month period, and one was just days before giving birth and the second was about two months after? Is this considered symptomatic and therefore a surgical candidate? Or should a watchful waiting be recommended prior to referring for surgery?

 

[surgres88]

Asymptomatic = no symptoms.
Attacks = symptoms = symptomatic.

 

[facetguy]

Asymptomatic = no symptoms.
Attacks = symptoms = symptomatic.

Even if the attacks are few and far between? That was the gist of my question.

 

[JackADeli]

Even if the attacks are few and far between? That was the gist of my question.

Yes.
What you describe is NOT asymptomatic gallstones incidently discovered. If your presentation is accurate and patient is having "attacks" as a result of gallstones.... then this is symptomatic cholelithiasis.

 

[facetguy]

Yes.
What you describe is NOT asymptomatic gallstones incidently discovered. If your presentation is accurate and patient is having "attacks" as a result of gallstones.... then this is symptomatic cholelithiasis.

Gracias.🙂

 

[Winged Scapula]

You have described the classic presentation of cholelithiasis/choledocholithiasis/biliary dyskinesia. She is symptomatic.

A waxing and waning course is typical.

Sounds like the woman you describe needs to be surgerized.

 

[JackADeli]

You have described the classic presentation of cholelithiasis/choledocholithiasis/biliary dyskinesia. She is symptomatic.

A waxing and waning course is typical.

Sounds like the woman you describe needs to be surgerized.

The question/s she must ask herself is:

does she want the gallbag removed through her vagina? maybe through stomach? single incision (i.e. SILS or LESS)? or, is she old school and want to go by way of multiple abdominal ports or single subcostal incision?

ps: if she waits, I think the NOTES investigators are trying to perfect a technique to take it out through her anus.

 

[facetguy]

The question/s she must ask herself is:

does she want the gallbag removed through her vagina? maybe through stomach? single incision (i.e. SILS or LESS)? or, is she old school and want to go by way of multiple abdominal ports or single subcostal incision?

ps: if she waits, I think the NOTES investigators are trying to perfect a technique to take it out through her anus.

Are these other non-'old school' techniques considered perfected or are they still experimental?

 

[JackADeli]

Are these other non-'old school' techniques considered perfected or are they still experimental?

The SILS & LESS technique are really not experimental. They aren't completely mainstream yet, either. But, an uncomplicated cholecystectomy via single umbilical incision can be performed in under an hour. There is no longterm hernia data on this procedure.

http://www.covidien.com/campaigns/pagebuilder.aspx?topicID=171910&page=SILS:Main
http://www.advancedsurgical.ie/TriPort/Default.166.html

As for the NOTES type procedures, transvag is being done, but I think in general they are all currently experimental. Some centers will offer trans-vag option as part of their IRB approved protocols.

 

[Winged Scapula]

I prefer my gallbladder to come out through my abdominal wall, thank you.