Gallbladder Cancer after laparoscopic cholecystectomy is called as incidental gallbladder cancer. It is generally of low stage cancer as it is diagnosed incidentally. It require completion radical cholecystectomy surgery
What is Incidental Gallbladder Cancer
True incidental gallbladder cancer is diagnosed on histopathology report when gallbladder specimen is sent for biopsy. It is different from missed gallbladder cancer which has got poor prognosis. Gallbladder cancer can be missed pre-operatively when there is suspicious of gallbladder cancer but it is not worked up further.It can also be missed intra-op if gallbladder specimen is not cut and examined intra-operatively. It is always advised to cut open the specimen during surgery and any suspicious area of cancer is send for frozen section biopsy and proceed accordingly
Does all gallbladder cancer after laparoscopic cholecystectomy require surgery
Not all gallbladder cancer after laparoscopic cholecystectomy require surgery. T1a stage and metastatic disease does not require surgery. Patient fitness for surgery is required
Investigation to be done when biopsy show gallbladder cancer after laparoscopic cholecystectomy
Surgery is not done for metastatic disease.PET scan is done to rule out metastatic disease.
What is completion radical cholecystectomy
In completion radical cholecystectomy liver wedge is removed which is part of gallbladder bed. Lymphadenectomy is also done. Before proceeding to radical surgery if even PET scan is negative for metastatic disease, staging laparoscopy is done. It is done to identify metastatic deposits which are missed even on PET scan
What is prognosis of gallbladder cancer after laparoscopic cholecystectomy
Prognosis depend on the stage of cancer. Early stage tumor has got good prognosis. Data has shown that patient who undergo radical cholecystectomy after diagnosis of incidental gallbladder cancer has got good survival rate compared to those who do not. Bile spillage during index surgery also carries a poor prognosis
The incidence of Gallbladder stone has increased as Ultrasound abdomen has become very common investigation for pain abdomen. Best Gallbladder stone doctor is the Laparoscopic surgeon as the recommended treatment is surgery
Symptoms due to gallbladder stone
Pain which is localized to right upper abdomen is the most common complain. Pain occur due to cystic duct obstruction caused by stone and is colicky in nature. The pain of biliary colic generally last less than 4 hr and if pain persists then patient may have associated cholecystitis. Sometimes patient present with symptoms due to associated stone complications like jaundice,cholangitis, pancreatitis
Diagnosis of Gallbladder Stone
Any kind of pain abdomen because it is non-invasive ultrasound abdomen is the investigation of choice. USG abdomen can show stones in the gallbladder and other any associated disease like CBD stone. Indication for MRI/MRCP is deranged LFTs with dilated CBD and no common bile duct stone in USG. MRI/MRCP is more sensitive for detection of Common bile duct stones then USG abdomen. Even in some case when there is doubt EUS ia also done
Best gallbladder stone doctor
Best gallbladder stone doctor is the laparoscopic surgeon as recommended treatment worldwide is surgery. Minimally invasive surgery is another name of Laparoscopic surgery as the incision used is minimum. Advantage of laparoscopic surgery is that there is less pain after the surgery. Less pain allow early mobilization of patient and early discharge from the hospital. From next day onwards patient can do all his normal day to day activities
Dietary precautions after Gallbladder removal surgery
Patient is advised not to have high fat diet for next 2-3 months after surgery. Pt can have normal fat intake but not in excessive amount.
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Gallbladder stone incidence has increased as Ultrasound abdomen has become very common investigation for pain abdomen. Best doctor gallbladder stone treatment is the Laparoscopic surgeon. The treatment of choice is Laparoscopic cholecystectomy.
Gallbladder stone symptoms
The most common symptom which patient complain is pain localized to the right upper abdomen. Pain is colicky in nature and it occurs due to the stone which causes obstruction at the cystic duct. Biliary colic pain lasts for less than 4 hr. The pain of acute cholecystitis is persistent. If a patient has associated complication due to stone like pancreatitis, cholangitis then the patient will have symptoms associated with these complications also. These symptoms can include jaundice, severe pain abdomen radiating to the back.
Diagnosis of Gallbladder stone
The most common investigation that is used for any pain abdomen is Ultrasound. It will detect stones in the gallbladder and can detect other associated pathology. If CBD is dilated and LFTs are deranged and there is no CBD stone in USG abdomen then MRI/MRCP is done which is more sensitive than USG for detection of Common bile duct stones.
Best doctor gallbladder stone treatment
Best doctor for gallbladder treatment is surgeon as the only recommended treatment is surgery. Laparoscopic cholecystectomy is done by laparoscopic surgeon. Laparoscopic surgery is also called as minimally invasive surgery as the incision used is minimum. Advantage of minimal incision is that there is less pain in the post-op period. A patient will be mobilized early and early discharge.
Diet after Gallbladder removal surgery
There is no special diet. It is important to understand that gallbladder removed in gallbladder stone is not a normal gallbladder. It has already lost its function. Function of gallbladder is just storage of bile. Generally, pt is advised not to have heavy fatty for 2-3 months after surgery.
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There are two types of stones in the common bile duct. one is primary CBD stones and other is secondary stones. Primary common bile duct stone form primarily in the CBD (Common bile duct) only whereas when the stone in the gallbladder slips into the common bile duct these are called as secondary common bile duct stones.
Symptoms of CBD stones
Common bile duct stones may be asymptomatic but when symptomatic the most common symptom is pain abdomen which may be mild to moderate. Pain is usually located on the right upper abdomen. When Common bile duct stone causes complete obstruction of CBD patient will have jaundice. The typical feature of obstructive jaundice is pale colored stool and itching due to deposition of bile salts. If obstructed bile gets infected patients may have a fever. The triad of fever/jaundice/pain abdomen suggest cholangitis and require immediate intervention.
Diagnosis of CBD stones
USG abdomen can show large common bile duct stones but it can miss small one. For better delineating small stones, MRI/MRCP abdomen is done. Endoscopic ultrasound is available for even small stones missed on MRI. Now the recommendations are EUS guided ERCP means as small stones may pass spontaneously before doing ERCP EUS should be done and if it shows stones then the only ERCP should be done
Treatment of CBD stones
The primary treatment of Common bile duct stone is Endoscopic stone removal (ERCP stone removal). Chances of ERC stone removal is less if there are multiple and large stones. Treatment of failed ERC is surgical removal of CBD stones.
The surgical options are CBD exploration and CBD stone removal with
(A) primary closure of CBD
(B) T-tube drainage
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Dr Amit jain is renowned laparoscopic surgeon in Noida Ghaziabad Delhi India. He is known for Laparoscopic CBD stone removal in East Delhi
Dr. Amit Jain is a Best laparoscopic surgeon in Delhi NCR Noida region of India. Advance laparoscopic surgeon who specializes in GI Surgery. Performed the first bariatric or weight loss surgery in Greater Noida region of Uttar Pradesh. He is also the one who performed the first bariatric surgery in Kumaon region of Uttarakhand at Medicity hospital in Rudrapur.
He completed his MBBS from Kasturba Medical College in Mangalore. He has done Masters in Surgery from Gandhi Medical College in Bhopal. After that, he completed his MCh in GI Surgery from GB Pant Hospital in Delhi.
He has done his senior residency at ILBS hospital Vasant Kunj at Delhi where he got experience in the field of Liver Transplant. After completing his MCh he joined Dayanand Medical College in Ludhiana and worked there as Assistant professor in Dept of GI Surgery. He has also worked in Nayati Hospital in Mathura as Consultant in Dept of GI Surgery. After that, he worked as a Consultant in GI & Bariatric surgery dept at JP Hospital in Noida. Currently, he is a senior consultant in dept of GI Surgery and GI Oncology at Max Hospital in Patparganj Delhi and in Max Hospital at Vaishali in Uttar Pradesh.
Fellowship done by Dr. Amit Jain Best Laparoscopic Surgeon
He has done a fellowship in Advance laparoscopic GI Surgery and in Minimal Access Surgery. He is a fellow in Indian Association of Gastrointestinal Endo surgeon.
Special Interest & Expertize
He has expertized in Hepato-pancreato-biliary surgery and in Bariatric surgery. He has a special interest in Laparoscopic Gastrointestinal Cancer Surgery.
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Gallbladder stone disease is common especially in the Northern part of India, The standard Gallbladder stone treatment worldwide is Surgery. There are so many theories given about the formation of gallbladder stone. But there are no preventive methods for gallbladder stone formation. Most common symptom patients complain is a pain in the right upper abdomen. When ultrasound of the abdomen is done for pain in the abdomen, stones are detected.
Surgery for Gallbladder stone treatment
The standard treatment for gallbladder stone worldwide is surgical removal of the whole of the gallbladder. It is called as Laparoscopically cholecystectomy as mostly it is done by means of laparoscopically. Laparoscopic surgery is done by small incisions. Small incisions mean there is less pain in the post-operative period. It allows early mobilization of the patient and early recovery in the post-operative period.
Indication of Open Cholecystectomy
Only in difficult cases or when it is expected that there will adhesions at gallbladder fossa open cholecystectomy is performed, In these cases also a trial of laparoscopy can be given. As the length of the incision is more recovery is late. When compared to laparoscopic surgery in open surgery patient is discharge late.
Advantages of Laparoscopic Surgery
Laparoscopic cholecystectomy come under day care surgery. It means if a patient is comfortable in the post-operative period, no complaints. accepting orally no vomitting then the patient can be discharged on the same day of surgery. The patient can do his normal day to day activity form next day onwards and can go to job also
Alternative gallbladder stone treatment
There is no role of other treatment options available for gallbladder stone treatment. Some homeopathic doctors claim so but no. It is advised for the patients do not go for these alternative treatment options available as a patient may develop complications.
Most frequently asked a question on gallbladder stone treatment
The most common question which is asked by the patients is whether the whole of the gallbladder is removed or only the stones are removed. As gallbladder is already not functioning the standard procedure is removal of the whole of the gallbladder. Gallbladder removal does not affect digestion. The only precaution is to avoid fatty diet for next 2-3 months. After this time patient can have a normal diet. There is no special diet after gallbladder removal
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Asymptomatic gallstones mean a patient is diagnosed to have gallstones but never have abdomen pain. Asymptomatic Gallstones disease is common. Ultrasound abdomen is the investigation of choice in any abdomen complaint. Being so much use of ultrasound abdomen the incidence of asymptomatic gallstones has increased. Management is controversial some recommend to go for gallbladder removal while other say it should be removed only when symptomatic.
Complications of Asymptomatic Gallstones
Now the question arises should gallbladder be removed or not. Gallbladder stone disease have various complications like jaundice/cholangitis/pancreatitis/Gallbladder Cancer. It is said that the first presentation with these complications are rare, the first patient will have the pain of gallbladder stone and if not treated then the
rate of these complications increases but there are few patients also who present directly with gallbladder stone complications and sometimes these complications are life-threatening also. The rate of complications does not depend on the size and the number of gallbladder stones.
Gallbladder removal is called as cholecystectomy. It is commonly done by laparoscopic approach thats why it is called as laparoscopic cholecystectomy. Laparoscopic cholecystectomy is a day care procedure. Patient is discharged on the same day of surgery and from next day onward can do normal day to day activity. This is the reason why some recommend doing Laparoscopic cholecystectomy in asymptomatic patients also . Because the complication rate of leaving behind the gallbladder is more rather than removing it. There is no major change in diet after gallbladder removal. Generally high fat diet should be avoided for next 2-3 months after surgery. After this period patient can have normal diet
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To have more knowledge about asymptomatic gallstones consult Dr Amit Jain best gallstone surgeon in noida ghaziabad indrapuram east delhi India
Gallbladder Cancer Specialist team include Gallbladder Oncologist & Gallbladder Cancer surgeon. This team act as a unit to deal with Gallbladder Cancer. Gallbladder Cancer if resectable then surgery is done by Oncosurgeon. If it is not resectable then chemotherapy is given by Medical Oncologist.Incidence has increased in young population also
More common in North India. High incidence is seen in female sex. Most common complain is pain in right upper abdomen. Anorexia and weight loss which are symptoms of any cancer are present. Most cases are diagnosed in advanced stage when the tumor is unresectable. Early diagnosis and treatment is key for the good survival rate as in any cancer
USG abdomen can show mass or focal thickening in the gallbladder. CECT abdomen is done to stage the tumor. FNAC is not done as it may risk the seedling of cancer cells in the needle tract. PET scan is done selectively
Treatment of Gallbladder Cancer
Gallbladder is situated on the inferior aspect of right lobe of liver adhered to it. Gallbladder is removed along with this part of liver to which it is adhered. Standard lyphadenectomy along with resection this whole procedure is called as radical cholecystectomy. Cystic duct margin is sent for frozen section intra-operatively and if it comes to be positive then common bile duct is also excised and then Roux-en-Y Hepatico-jejunostomy is performed. Extended right hepatectomy is done if tumor is located at the neck and involve right sided portal structures.
Role of staging laparoscopy
Staging Laparoscopy is the first step. It is done to look for metastatic deposits missed on CT scan. If metastatic deposits are seen on staging laparoscopy then biopsy is taken from the deposits and sent for frozen section and if these comes to be positive then surgical procedure is abandoned
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Esophagus is food pipe that connects from mouth to stomach or in other words it carries food from the mouth to the stomach. Esophagus cancer incidence is increasing. The length of esophagus is divided into three parts upper third, middle third and lower third
Cause of Esophagus Cancer
Cause of lower third cancer is obesity and gastro-esophageal reflux disease. Histologically lower third cancer is adenocarcinoma. Cause of middle and upper third cancer is smoking and alcohol. Histologically it is squamous cell carcinoma
Cancer causes obstruction to the passage of food bolus. The most common symptom these patients complain is dysphagia that is difficulty in swallowing food. These patients adapt there food intake, when they have dysphagia to solid food they start eating soft diet and when narrowing does not allow soft diet they start taking liquid diet the most common presentation. Anorexia and weight loss are common symptom. In advanced cancer patient can have pain over the bone, hoarseness in the voice
Upper GI endoscopy is the main diagnostic tool. when patient present with complain of dysphagia the first investigation to be done is upper GI endoscopy. Biopsy taken at this time proves the diagnosis. CECT chest and abdomen is done for the staging.PET Scan is done in the selected cases only
The main stay of treatment of esophagus cancer is surgery. For this tumor should be resectable and patient should be fit. In locally advanced tumor before surgery chemo-radiotherapy is given. In metastatic disease palliation is required. As the main symptom is dysphagia esophagus stenting is done. This is done by upper GI endoscopy. If this is not possible feeding jejunostomy is done
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The most common cause of acute pancreatits are alcohol intake and the gallbladder stone. When acute pancreatitis is caused by biliary stones it is called as biliary pancreatitis. Biliary pancreatitis management involve team work of critical care doctor, Gastrophysician, Gastrointestinal surgeon & intervention Radiologist
Patients present with features of acute pancreatitis like severe acute abdomen pain radiating to back; Investigations show increased serum amylase and Lipase level with deranged Liver function tests (LFT)
Biliary pancreatitis management
Biliary pancreatitis management is supportive. To know the status of Common bile duct MRI/MRCP abdomen is done. Mostly stone has passed through the Common bile duct into the duodenum. If the MRI/MRCP show stone in the common bile duct then patient require ERCP and CBD stone clearance. If the patient condition is not stable and is in cholangitis/septic shock ERCP is done on urgent basis otherwise ERCP is done on elective basis once pancreatitis settle.
The Gallbladder is removed during same hospitalization in mild biliary pancreatitis management with no associated fluid collection as gallstone is the cause and is the source and if not removed patient may again develop pancreatitis. Cholecystectomy is advised after 4 weeks in moderate and in severe biliary pancreatitis management as if some comlications of pancreatitis requiring intervention, that can also be done at same time. Indications for surgery for pancreatitis remains the same such as infected pancreatic necrosis. Pancreatic necrosectomy should be delayed and ideally should be done after 4 weeks of episode.
Know more on Pancreatitis
Pancreatitis disease is common with very high morbidity and mortality rate. Alcohol is the most common culprit and should be avoided. Dr Amit Jain with his advance laparoscopic approach is specialize to do pancreatic necrosectomy with minimally invasive approach which has got low morbidity and mortality. To have regular update about this topic plz visit and like our facebook page
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