Gallbladder Stones

Gallbladder Stones

What are gallstones?

Gallstones are stones that form inside the gallbladder. They are common and can run in families. In some cases they can cause symptoms or complications that require treatment. In this leaflet you will find the basic information about this condition and its treatment options. If you have any further questions, please feel free to contact your surgeon at DAE (LINK to Surgeon Page).

In Depth Info

What is the Gallbladder?

The gallbladder is a small pouch shaped organ located on the underside of your liver. Bile is stored in the gallbladder, which contracts after a meal and empties the bile into the small intestine where it mixes with the ingested food, facilitating digestion of fats and certain vitamins. The presence of gallstones may hinder this function and cause pain or further complications described below.

What exactly are gallstones?

Gallstones are stones that can develop in the gallbladder, due to certain imbalances in the constituents of bile. Some individuals are at higher risk than others for developing gallstones:

  • Female gender
  • Reproductive age
  • Pregnancy
  • Excess weight or obesity
  • High fat diet
  • Rapid weight loss and weight fluctuations
  • Prolonged fasting
  • Family history of gallstones
  • Sedentary lifestyle

How can gallstones cause problems?

For some people, gallstones can cause symptoms and, in some cases, severe complications if left untreated. Most of the symptoms and complications are due to obstruction of bile flow caused by the stones.

  • Biliary Colic
    • Transient obstruction in the gallbladder leads to repeated attacks of severe abdominal pain following meals, as the stones prevent the emptying of the gallbladder
  • Acute Cholecystitis
    • Persistent obstruction in the gallbladder leading to inflammation and / or infection of the gallbladder
    • Severe, persistent pain and fever can develop
  • Stone migration and Biliary Obstruction
    • This is a serious complication of gallstones. In this case, the stones have moved out of the gallbladder and may obstruct the main bile ducts.
    • This causes jaundice (yellow discoloration of skin and eyes).
    • The obstructed bile can also become infected, a condition known as Cholangitis, and is a serious life-threatening emergency requiring urgent medical and surgical care

How are gallstones diagnosed?

Typically gallstones are seen on abdominal ultrasound done for any other concern (incidental discovery), or done for abdominal pain suspected to be related to gallbladder disease. Other imaging modalities such as CT scans or MRIs may be used.

My GP discovered that I have gallstones, but I have never felt any of the symptoms described in this leaflet. Do I need any treatment?

The short answer is no. If you do not experience the classic symptoms of biliary colic or have any evidence of the complications described above, there is no need for any intervention. However, you are now aware of the potential symptoms and should contact your healthcare team promptly as soon as you feel any of them.

What is the best treatment for symptomatic gallstones?

Surgery. Laparoscopic Cholecystectomy is the only dependable way to cure the condition. It is done using keyhole incisions, 5-10 mm in length, and consists of the complete removal of the gallbladder along with its contents.

What does the operation involve?

The procedure is done under general anesthesia. The surgeon will use keyhole incisions to minimize scarring and postoperative pain. The abdomen is inflated using CO2 gas to create working space for the surgeon. The gallbladder is viewed on a high definition monitor using a special camera attached to the laparoscope. Special instruments are then used to manipulate the gallbladder. The duct and artery that service the gallbladder are clipped shut. The gallbladder is cut free from the liver and is pulled out through one of the keyhole incisions along with its load of gallstones. The incisions are closed up and covered with dressings.

The duration of a standard laparoscopic cholecystectomy ranges from 30 to 60 minutes.

What can I Expect After Surgery?

  • You can usually go home within 24 hours of the operation.
  • You can expect some
    • Some mild postoperative pain:
      • At the incisions
      • In your shoulders (due to residual gas in the abdominal cavity)
      • In your intestines (due to gaseous distention)
    • You may feel some bloating
      • This is due to a tendency of the intestines to slow down their transit after anesthesia and abdominal operations in general
      • This may also lead to a transient disturbance in bowel habits
    • Return to normal activities within 24-48 hours
    • The surgeon will recommend a low fat diet for a few weeks after surgery to allow your digestive system to recover and adjust.

Are there any alternatives to surgery?

Despite the presence of some conservative treatment options, surgery is the only dependable way to get rid of gallstones and their complications for good.

Medical treatment with ursodeoxycholic acid is an option but not practical. It is applicable only to a small subset of patients, and the therapy can take 9-12 months to dissolve the stone in only 50% of cases.

Extracorporeal Shockwave Lithotripsy is another option whereby the gallstones are fragmented using external means. This technique also has significant limitations. A diseased gallbladder might not be able to expel the stone fragments.

A healthy, portion-controlled, low-fat diet high in fruits and vegetables can help keep attacks to a minimum, but will not lead to disappearance of gallstones and definitive management is still needed in symptomatic cases.

 

In essence, conservative treatment options are reserved for patients who are generally unfit for surgery.

What are the benefits of surgery?

Resolution of the pain caused by gallstones, and avoidance of their complications in the future.

Q: Will I have scars after surgery?

Any incision will heal and form a scar. That is how the healing process works, and without it, any form of surgery would be impossible. That said, the advantage of laparoscopy means you will get tiny keyhole incisions, as opposed to the large ones needed for open surgery. The use of tiny incisions, coupled with the use of cosmetic skin closure techniques and absorbable intracorporeal sutures, means that the scarring is kept to a strict minimum, and will be barely noticeable as time goes by.

Will I have any long-term effects from surgery?

The gallbladder serves only as a reservoir for the bile, and as such is not a vital organ for the digestive system. The liver produces more than enough bile to ensure adequate digestion, however, there will be a short period of adjustment during which you may experience some dyscomfort after a heavy fatty meal. This is why a low fat diet is recommended during this recovery period, after which everything will return to normal.

What about weight gain after cholecystectomy?

There is no strong medical evidence to suggest any direct relationship between gallbladder surgery and postoperative weight gain. A small percentage of patients experience some weight gain, but this is generally related to lifestyle factors rather than the operation itself. In fact, most patients actually lose weight in the perioperative period, and that is due in part to the low fat diet they are instructed to take, and also to transiently impaired fat absorption associated with the procedure.

Conclusion

Laparoscopic Cholecystectomy is a safe and minimally invasive operation performed to treat symptomatic gallstones and their complications. While experience varies from patient to patient, it is generally accepted as an easy and tolerable operation with quick recovery times and return to normal activity, and scarring is kept to a minimum. Post-operative pain is minimal and managed with simple analgesics, and the procedure carries no long-term consequences. This leaflet is designed to provide you with the basic information about what to expect before and after your operation. If you have any concerns or questions feel free to book your next appointment to discuss your case with your physician at DAE.

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