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Gallstones are formed when the liquid crystallize into pieces of stone-like materials. The liquid called bile, which is made in the liver and stored in the gall bladder, helps the body to digest fats. When the body needs to digest fats, the gall bladder contracts and pushes bile into a tube, called the common bile duct, and drains bile to the small intestine for lipid digestion. Cholesterol stones are formed when bile contains excessive cholesterol or bilirubin, or not enough bile salts, or when the gall bladder does not empty well. Gallstones may exist in the gall bladder or in the bile duct.

Problems Associated with Gallstones
Gallstone symptoms are similar to those of peptic ulcers, indigestion and irritable bowel syndrome, thus accurate diagnosis is very important.

Ways to Treat Gallstones
The use of surgical method to remove the gall bladder, called cholecystectomy, is the commonest way to treat symptomatic gallstones.

Conventionally, operations to remove the gall bladder are performed through an abdominal incision of 10 cm. It is a major surgery and may require about 2-7 days of hospital stay. In operations to open the gall bladder and remove the gallstones in the bile duct, the fluid from the incision and bile from the bile duct will require draining to the outside. The bile duct tube may need to stay inside the body for about ten days before removal. Patients then have to stay for 2 weeks in the hospital. Nowadays, these operations can be performed using minimally invasive technique.

Treating Gallstones by Minimally Invasive Surgery

Laparoscopic cholecystectomy
Laparoscopic cholecystectomy can be performed by utilizing several small incisions of 1 cm or smaller in the abdomen and insert surgical instruments and a miniature video camera into the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. While watching the monitor, the surgeon uses the instruments to separate carefully the gall bladder from the liver, ducts and other structures. Then the cystic duct is cut and the gall bladder removed through one of the small incisions.

Endoscopic retrograde cholangiopancreatography (ERCP)
Endoscopic retrograde cholangiopancreatography (ERCP) is performed when the gallstones are in the bile ducts using an endoscopic apparatus. An endoscope is a thin, flexible tube connected to a computer and TV monitor that enables the surgeon to see inside the bowels. The surgeon guides the endoscope to pass through the mouth, esophagus and stomach into the second part of the duodenum. X-rays with contrast medium are taken during ERCP to locate the affected bile duct. Then an instrument via the endoscope is used to enlarge the duct opening, through which the gallstones are captured and removed with a tiny basket.

Advantages of Minimally Invasive Surgery
An operation performed laparoscopically effects the same magnitude of operations as in open conventional surgery, while the former has advantages including less blood loss, smaller surgical scars, less wound pain, less wound infection, quicker recovery and shorter hospital stay (if any). When ERCP operation is performed, no incision of the abdomen is required and the surgical trauma is minimum.