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DURING A GALLSTONE SURGERY, ONLY THE STONES ARE REMOVED?

The above question concerns many patients who are about to undergo cholecystectomy due to cholelithiasis and express it during their visit to the surgeon. Primarily it results from confusion with other conditions such as kidney stones that can be treated with extracorporeal lithotripsy without surgery.

Studying the pathophysiology of gallstones briefly, we will also clarify the widely used terminology. BILE is the yellow-green solution of organic and inorganic constituents produced continuously by the liver, and its main role is the participation in digestion. It consists mainly of water, electrolytes, pigments, proteins, and lipids. A part of the daily bile production is stored in the GALL BLADDER, where it is dehydrated, in order to be used in cases where the body needs larger amounts of bile for digestion such as for high-fat meals.

Various causes (genetic, hereditary, nutritional, etc.) can lead to the disruption of bile synthesis and homeostasis in the body, resulting in the production of “lithogenic bile” responsible for gallstones, that is, stone formation. This occurs within the gall bladder where the bile is stored and pooled, initially by the precipitation and deposition of crystals (mud) and then by the aggregation of crystals into larger groups and their consequent formation into stones.

From the above, it is understood that the definitive treatment of the disease is the surgical removal of the entire gall bladder and not just the stones, as the latter will lead to the recurrence of the disease, i.e their re-creation. In addition, the gall bladder is an auxiliary organ of digestion and its removal does not have a major impact on the normal functioning of the organism, as it would in the case of nephrolithiasis if the complete kidney was to be removed in the first place.

Consequently, after cholecystectomy, the bile continues to be produced 24 hours a day by the liver and the digestion continues unrestricted. The only impact on the patient is to maintain a specific diet for a short period of time so that his body can adapt to the new conditions of gallbladder shortage, the bile depot.