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Medical Forum / General / General / March 2005Gallstone surgery
Hello, I have just been diagnosed with gallstones. I expect to have surgery shortly. I have a few questions for anyone who has experienced this sort of problem. I am in my early forties, living in Canada. The stones, detected by ultrasound, are up to 2cms in diameter. Are stones of this size too large for a laparoscopy? What size stones, whilst waiting for the surgery, could be a potential danger for blockage? Are there any dietary concerns I should consider meanwhile? What are the concerns I should have over this type of surgery (gallbladder removal)? Any words of wisdom would be most welcome! Many thanks! > Hello, > [quoted text clipped - 6 lines] > > Are stones of this size too large for a laparoscopy? No. > What size stones, whilst waiting for the surgery, could be a potential > danger for blockage? These. > Are there any dietary concerns I should consider meanwhile? Talk with your surgeon. > What are the concerns I should have over this type of surgery > (gallbladder removal)? Death. Disability. Pain. The first two are rare but not unheard of. > Any words of wisdom would be most welcome! Talk with your doctor about these concerns. She has examined you, seen your studies and knows your history. Jeff > Many thanks! > > Hello, > > [quoted text clipped - 35 lines] > > > Many thanks! I was slated for gall bladder surgery and about a two weeks to 10 days prior decided to stop taking LIPITOR for a bit. My gall bladder disease, pancreatitis, gastric reflux and unremitting helicobactor pylori ulcer began to clear up. I cancelled the surgery. I have not had similar problems since. And had not before. In me, and many others with whom I correspond on this topic, LIPITOR and other STATINS caused gall bladder disease. In me, LIPITOR was going to cause gall bladder surgery. http://www.rxlist.com/cgi/generic/atorvastatin_ad.htm "Digestive System: Nausea, gastroenteritis, liver function tests abnormal, colitis, vomiting, gastritis, dry mouth, rectal hemorrhage, esophagitis. eructation, glossitis, mouth ulceration, anorexia, increased appetite, stomatitis, biliary pain, cheilitis, duodenal ulcer, dysphagia, enteritis, melena, gum hemorrhage, stomach ulcer, tenesmus, ulcerative stomatitis, hepatitis, pancreatitis, cholestatic jaundice." Zee I was slated for gall bladder surgery and about a two weeks to 10 days prior decided to stop taking LIPITOR for a bit. My gall bladder disease, pancreatitis, gastric reflux and unremitting helicobactor pylori ulcer began to clear up. I cancelled the surgery. I have not had similar problems since. And had not before. In me, and many others with whom I correspond on this topic, LIPITOR and other STATINS caused gall bladder disease. In me, LIPITOR was going to cause gall bladder surgery. Very reasonable if you don't have gallstones. If you have gallstones, the problem is the gallstones, not the lipitor. HMc My point is that gall bladder disease, which would include stones and 'sand', may be caused by statins. If the OP is taking a statin, she could discuss with her physician the option of stopping her statin for a couple months to see if her gastrointestinal problems clear up. As they did with me. Zee > My point is that gall bladder disease, which would include stones and > 'sand', may be caused by statins. If the OP is taking a statin, she > could discuss with her physician the option of stopping her statin for > a couple months to see if her gastrointestinal problems clear up. As > they did with me. My point was that once formed, for whatever reason, the gallstones won't go away even by stopping statins. Their presence is what's causing the gallbladder symptoms, and putting her (and your) health at risk. HMc > > My point is that gall bladder disease, which would include stones and > > 'sand', may be caused by statins. If the OP is taking a statin, she [quoted text clipped - 7 lines] > > HMc But if their presence never causes symptoms or disease again (as in my example after stopping LIPITOR) then why have surgery? Zee >> > My point is that gall bladder disease, which would include stones > and [quoted text clipped - 15 lines] > But if their presence never causes symptoms or disease again (as in my > example after stopping LIPITOR) then why have surgery? The Lipitor has already caused disease, and that disease has already caused symptoms. Generally, a surgeon wouldn't operate for asymptomatic gallstones. However, the OP, and you, don't have asymptomatic gallstones. The next time you have symptoms, they may be the result of acute cholecystitis, gangrenous cholecystitis, acute pancreatitis, choledocholithias (with or without cholangitis). Pretty typical stuff, and things that typical surgeons see at least a couple of times a month. The issue you describe is pretty basic - medical school stuff, but you can argue it all you want. The decision to have surgery is entirely yours. HMc > >> > My point is that gall bladder disease, which would include stones > > and [quoted text clipped - 29 lines] > > HMc I have been asymptomatic for seven years. The reason for having the surgery is gone in my opinion, and in the opinion of the surgeon. The next time I have symptoms? Since we do not know if or when there will be a next time ... But I could have symptoms even if I had surgery. They would be different ones. The surgeon told me all about them. Zee Zee > I have been asymptomatic for seven years. ..which has nothing to do with your stopping Lipitor > The reason for having the surgery is gone in my opinion, and in the > opinion of the surgeon. The next time I have symptoms? Since we do not > know if or when there will be a next time ... > > But I could have symptoms even if I had surgery. They would be > different ones. The surgeon told me all about them. You can have gallbladder symptoms after your gallbladder has been removed? Perhaps you misunderstood your surgeon. HMc > > I have been asymptomatic for seven years. > > ..which has nothing to do with your stopping Lipitor Why do you think that? You must have something in mind which it does have to do with. > > The reason for having the surgery is gone in my opinion, and in the > > opinion of the surgeon. The next time I have symptoms? Since we do not [quoted text clipped - 5 lines] > You can have gallbladder symptoms after your gallbladder has been removed? > Perhaps you misunderstood your surgeon. Removing one's gallbladder removes the symptoms of gall bladder disease but there can be side effects to not having a gall bladder. "They would be different ones." But please; tell me why my being asymptomatic of gall bladder disease from within days of stopping LIPITOR to now has nothing to do with stopping LIPITOR. Zee > > HMc > But please; tell me why my being asymptomatic of gall bladder disease > from within days of stopping LIPITOR to now has nothing to do with > stopping LIPITOR. Gallstones are a mechanical problem. It's not really believable that stopping atorvastatin would cause gallbladder symptoms (biliary colic) due to gallstones to immediately go away -- the stones aren't going to dissolve over a few days. If stopping the atorvastatin really had a causal affect on the resolution of the symptoms, it would seem more likely that the symptoms the atorvastatin was causing were not actually gallbladder symptoms but rather some other gastrointestinal symptoms that seemed like gallbladder symptoms. There's no simple way to sort this out. Even ignoring the issue of atorvastatin, lots of people have gallstones and lots of people have abdominal discomfort (including right upper quadrant discomfort) and in only some of those people is the abdominal discomfort due to the gallstones.  SignatureDavid Rind drind@caregroup.harvard.edu > > But please; tell me why my being asymptomatic of gall bladder disease > > from within days of stopping LIPITOR to now has nothing to do with [quoted text clipped - 12 lines] > issue of atorvastatin, lots of people have gallstones and lots of people > have abdominal discomfort (including right upper quadrant discomfort) > and in only some of those people is the abdominal discomfort due to the > gallstones. > > -- > David Rind > drind@caregroup.harvard.edu It didn't immediately go away. When you are in a lot of pain and it recedes, it just *seems* immediate. I didn't have gallbladder disease? Whew! All the more reason to be glad I didn't have gallbladder surgery. Is your quibble with me because I think LIPITOR can cause gall bladder disease? I know too many other LIPITOR users who had or have had similar gastrointestinal problems. A couple physicians. I know I cannot say with certainty LIPITOR caused gall bladder disease in me. But it is something the OP (if she is taking a statin) might consider. And you too, if you have patients taking LIPITOR who present with similar symptoms. Zee >>>But please; tell me why my being asymptomatic of gall bladder > [quoted text clipped - 58 lines] > consider. And you too, if you have patients taking LIPITOR who present > with similar symptoms. No, I wasn't quibbling with the assumption that Lipitor can cause gallbladder disease. I don't know that Lipitor causes gallbladder disease, but I'm willing to assume it's true for the purposes of this thread. I'm also assuming that by gallbladder disease you mean pain related to gallstones -- if Lipitor somehow directly inflamed the gallbladder, I suppose it could get better right away after stopping the drug. Drugs don't usually cause cholecystitis directly, however, and if you had cholecystitis you would likely have gone urgently for surgery, so I'm assuming that isn't what your doctor felt you had. Lipitor definitely causes abdominal pain in some people and rarely causes something called cholestatic jaundice. In someone who also had gallstones (which are usually asymptomatic), these symptoms could lead to a doctor concluding that the gallstones were causing the symptoms when it was really the Lipitor. (By the way, this is in no way unique to statins -- lots of drugs cause GI symptoms.) But this is all just wild speculation. Gallstone symptoms are tricky. Sorting this sort of thing out is why people are better off getting medical care from a live doctor who can see them than from the Internet. And even then, the doctor is likely to be wrong relatively often since there's no perfect way to prove that a given episode of abdominal pain is due to gallstones. SignatureDavid Rind drind@caregroup.harvard.edu Zee...people "quibble" with you I think because you have neither the knowledge nor the credentials to speak with authority on health related matters..which you do repeatedly.. > > > But please; tell me why my being asymptomatic of gall bladder > disease [quoted text clipped - 44 lines] > > Zee >> ..which has nothing to do with your stopping Lipitor > > Why do you think that? You must have something in mind which it does > have to do with. Nothing has been shown that would indicate that any of the statins directly cause inflammation of the gallbladder. We DO know that they can promote gallstone formation. So, the current concept is that statins can cause gallbladder disease by causing gallstones and the gallstones in turn cause the symptoms. It's the gallstones that cause the gallbladder symptoms, not the Lipitor. Furthermore, once the Lipitor has caused the gallstones, the gallstones are there forever - they won't go away once the Lipitor has been stopped. Now, Dr. Rind's suggestion that Z's GI symptoms weren't due to gallstones, but were more likely due to side effects of the Lipitor is a good one. Given the fact that he hasn't had a repeat problem with them in 7 years, Lipitor-induced, non-gallbladder abdominal pain represents the most likely situation in his case. If one accepts this scenario, he most likely does have asymptomatic gallstones. HMc >> But if their presence never causes symptoms or disease again (as in my >> example after stopping LIPITOR) then why have surgery? > HMcH the next time you have symptoms, they may be the result of acute > cholecystitis, gangrenous cholecystitis, acute pancreatitis, > choledocholithias (with or without cholangitis). Pretty typical stuff, and > things that typical surgeons see at least a couple of times a month. and not fun either. moreover if the stones increase in size as a result of delay, the laparascopic procedure may become infeasible, I've heard. > and not fun either. moreover if the stones increase in size > as a result of delay, the laparascopic procedure may become > infeasible, I've heard. Nah...the size and/or number of the gallstones is generally irrelevant to the feasibility of laparoscopic cholecystectomy. Acute inflammation, gangrene of the gallbladder, suppurative perforation, or Mirizzi's Syndrome can provide a challenge to a laparoscopic approach, however. I've seen all of these entities within the last 6 months - they aren't terribly uncommon. HMc > Hello, > [quoted text clipped - 6 lines] > > Any words of wisdom would be most welcome! Avoid fatty (greasy) meals in the meantime. A relative had disolution procedures. As far as I can remember they didn't work. A friend was misdiagnosed and then subsequently delayed the surgery. She paid in suffering and numerous visits to ER in order to get them to speed up the surgery date. She had laproscopic surgery. She does have residual discomfort when sleeping on that side - a stitch-like pain. She still has problems with certain foods but other factors may be involved. I had open surgery when I was much younger. (in Quebec) The "price" was having to stay in hospital longer and two painful post-surgical days. The female surgeon was excellent. Other than that, the healing was speedy. I could eat whatever I wanted and/or agreed with me afterwards. Another (co-worker) develped pancreatitis due to delaying surgery for gallstones. I think she had laproscopic surgery to remove and has continued to have chronic pancreatitis. My message is don't delay any longer than necessary. http://digestive.niddk.nih.gov/ddiseases/pubs/gallstones/ http://www.gicare.com/pated/ecdgs17.htm >Hello, > [quoted text clipped - 15 lines] > >Many thanks! Smaller gallstones are more likely to cause bad trouble by plugging up the common bile duct, but the ones that you have could certainly cause pain by blocking the cystic duct. I assume you've had symptoms from your gallstones (pain), as we don't usually operate on gallstones unless they are causing a problem. You should be able to have a laparoscopic surgery, unless you have had previous abdominal surgeries in the mid to upper abdomen. The best time to have surgery is before you have another attack, since emergent surgeries or the need to remove stones from the common bile duct is generally associated with some increased risk. H2 |
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