Read How to Do a Liver Transplant for Free Online

attacking them shortly after delivery.
    There is another, rarer, cause of gallstones and it is just a little bit revolting. In many parts of the developing world there are parasitic worms that, similar to the movie Alien , enjoy making themselves at home inside their human hosts. They live in the bile ducts and feast on the bile and the cells shed by their benefactor. Of course, what goes in must come out and these critters evacuate their bowels and fill the bile ducts with their little droppings. These deposits harden and eventually become stones. In addition, when these creatures die their carcasses contribute to the detritus. All of this is extremely irritating to the bile ducts and results in severe scarring, continual bouts of infection, cancer, and liver failure.
    Another strange thing about stones is that no one knows why some people’s gallbladders will go on the attack and why others will carry a gallbladder full of rocks around their whole lives with nary a care. Gallstones come in a spectacular array of shapes and sizes. There might be thousands of tiny little ones like grains of sand or a single stone the size of a chicken egg. Many of them are a beautifulpearlescent yellow and sharply faceted like a gemstone. Some patients even comment that they might be worthy of being fashioned into a necklace. Whatever the size, shape or number, these stones can all cause trouble – pain, jaundice, blood poisoning, inflammation of the pancreas, infection, cancer and death.
    Surgically removing a gallbladder – ‘cholecystectomy’ is the technical term – is a really great operation. No two gallbladders are the same and this adds to the enjoyment. Sometimes the surgery is really easy and it is all over in under an hour, and other times it is a three-hour extravaganza and I just wish it was over. And then, just when I think I’ve done the worst one I’ve ever seen, along comes another one that is even more terrible. Since the early 1980s, the operation has been done laparoscopically, that is, via keyhole surgery through four tiny cuts in the abdominal wall. The first time it was done this way, it took more than six painful hours, but thankfully we’ve got a lot better at it and I can now get an easy one done in under 30 minutes. Separating the patient from their gallbladder with laparoscopic surgery involves inserting a series of hollow tubes or ‘ports’ through the abdominal wall. To get the first port in, we make good use of nature’s doorknob – the belly button, a very convenient place to gain access to the abdominal cavity. Before the port is inserted, it is most important that the belly button is inspected to ensure it is sparkling clean. As it turns out, some people give verylittle thought to umbilical hygiene and it is not uncommon to find some significant concretions nestled deep in this little orifice. Using a pair of tweezers to relieve it of its lint, cleaning the belly button can be a surgical procedure in itself.
    Once a satisfactory state of cleanliness is reached, the belly button is grasped with a metal clamp and hauled upward. This lifts the abdominal wall off the bowels to avoid injuring them as a narrow tube is punctured through the skin and muscle. A gas hose is attached to this portal and carbon dioxide is pumped in, instantly inflating the tummy to around the size of a nine-month pregnancy. In their natural state, all the organs inside the abdomen are pressing against each other. Without the gas, there would be no separation and no space to operate in. The skin becomes translucent and tight as a drum, and once all the ports are in, the patient looks a little like a bloated porcupine. In keyhole surgery, all the action takes place on a TV screen. The picture is obtained by a long telescope attached to a camera that is passed through one of the portholes. Immediately, a magnified view of a rich red liver appears on several monitors scattered around the