New Jersey General Surgeon, Dr. Rocco Tutela, specializes in minimally invasive laparoscopic and robotic cholecystectomy. Cholecystectomy is the surgical removal of the Gallbladder.

Gallstones and the diseases which are caused by them, are the most common general surgical problem, that Dr. Tutela treats. While not all gallstones cause problems, those that do should undergo prompt surgical evaluation.

SIGNS AND SYMPTOMS

Pain, nausea, vomiting and fever are the most common indicators of gallstone disease. The pain typically occurs just under your breastbone or the right side of your ribs.  It can commonly radiate around to your back and shoulder blade as well. If left untreated severe illness may ensue and hospitalization is often required.

CAUSES

The liver creates bile which aids in the digestion of fat in your intestines.  Bile is a mixture of cholesterol, bile salts and lecithin. When perfectly balanced this watery fluid drains from the liver, via the bile duct, passes through a common channel within the pancreas and makes its way to the proximal portion of your intestines.  At the end of this channel is a muscle which opens a door when you eat and closes when you are not eating. When that door is closed bile backs up into the system and gets stored in the gallbladder. It is in the gall bladder where cholesterol crystallizes and forms gallstones.  In patients with bleeding disorders, gallstones form from the precipitation of bile salts. In either condition these crystals layer and form a sludge which eventually turn into gallstones. 

When you eat, a signal is sent to the gallbladder to contract and release its bile.  That same signal is also sent to the door to open at the end of your bile duct. In the natural state, bile will mix with the food you eat and help you absorb essential vitamins and other key elements to lead a healthy life. When gallstones are formed, however, the system can clog at different points along the way, causing different conditions.  

Pain under your breastbone and right side of your ribs is the most common sign that there is a problem with the system.  Crystals or stones can block the ducts causing the system to back up and swell. This swelling initially causes colicky pain, nausea and vomiting which can last hours.  Relief will occur if these stones eventually pass through to your intestines where they will be excreted.  

If the gallstones don’t pass, however, the swelling persists and naturally growing bacteria in the gut start to proliferate and cause fever and infection. At this point most people seek help from their physicians or go to their local emergency room or urgent care centers for treatment.

STONES CAUGHT IN THE DUCT

CHOLANGITIS AND CHOLEDOCHOLITHIASIS

When the gallstones pass beyond the gallbladder and its duct, they may get caught in the bile duct causing liver failure.  Jaundice or yellowing of the eyes and skin will accompany the signs and symptoms of cholecystitis. A more life-threatening condition cholangitis usually requires drainage of the bile duct prior to gallbladder removal.

GALLSTONE PANCREATITIS

If the gallstone gets caught further downstream, where it shares a common channel with the pancreas it will cause severe pain which radiates to the spine.  If this occurs, inflammation and infection of the pancreas may occur as well. Pancreatitis is the most severe consequence associated with gallstone disease. Since the pancreas contains chemicals or enzymes which are used to digest food, those same enzymes actually start to digest the bodies own organs causing major debilitating illness.  Gallstone pancreatitis is treated similarly to cholangitis whereby the duct needs to be cleared prior to gallbladder removal.

TREATMENT

If any of these conditions occur, the most prudent treatment is the prompt removal of the gallbladder.  If one becomes ill, intervention begins with IV fluid resuscitation and antibiotics. Cholangitis and gallstone pancreatitis may require drainage by a gastroenterologist or interventional radiologist, prior to the removal of your gallbladder.  Cholecystectomy is the most common general surgical procedure performed by Dr. Rocco Tutela and is always performed safely.

TECHNIQUE

Dr. Rocco Tutela, typically performs gallbladder removal (cholecystectomy), with minimally invasive (Laparoscopic) techniques.  More often he utilizes the DaVinci Robot to assist with this laparoscopic technique. In Dr. Tutela’s hands, Robotic Assisted Laparoscopic Cholecystectomy has proven to decrease operative time be the safest most effective way to getting his patient’s home in good health.  

From simple pain to systemic infection Dr. Tutela prides himself on his ability to recognize and treat the many different aspects of Gallstone disease. If you or a family member is suffering please do not hesitate to call him in consultation. He would be happy to answer your questions and guide you through what can be a difficult course