- 06 November 2019
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Gallbladder Removal Surgery to Treat Gallbladder Stones
I have gallbladder stones but I don’t have any symptoms? Sometimes I feel dull abdominal pain? Should I talk to my gastrointestinal surgeon and request him to prescribe some pills to dissolve my stone? I know that gallbladder stones can disappear with pills. These are the common concerns of the majority of the people who have gallbladder stones.
A few others think in the following way:
I think the removal of stone alone will address my problem – my gallbladder will be spared from being removed by surgery. I don’t think I have to undergo surgery as my gallbladder stone will be dissolved and removed over a period of time.
Some other patients ask: “Doctor! Do I need to remove my whole gallbladder or gallbladder stones alone can only be removed sparring my gallbladder?”
“Does the removal of gallbladder cause problems later in my life – Is it true doctor – as I heard from one of my friends saying this to me?”
These are some of the questions that we encounter in our practice regularly.
Let us try to address some of the concerns, the majority of the people have regarding gallbladder stones and gallbladder stone removal surgery.
What is Gallbladder?
The gallbladder is a small pear-shaped sac-like organ that lies below the liver in the upper right part of the abdomen below the front rib cage. It stores a digestive fluid called bile made by the liver. Bile is stored until needed. The Bile from the gallbladder is released into the small intestine to help in the digestive process.
What are Gallstones?
Bile is made of bilirubin and bile cholesterol. The bile hardens to form solid crystals or particles in the gallbladder. These particles are made from bilirubin and bile cholesterol. These are known as gallstones. Their sizes vary – some stones are very small and some are large. In some people only one gallstone forms, while others have many gallstones. Small stones are often problematic as they get stuck somewhere within the gallbladder or ducts and cause obstruction. Large stones sit confined to their position. Many people with gallstones do not have any symptoms – they never get bothered about them. In such cases, they come to know only when gallstones get accidentally detected in them.
There are two types of gallstones:
- Pigment stones: These stones are darker and smaller stones. These are made of bilirubin – which is produced by the liver and stored in the gallbladder.
- Cholesterol stones: The majority (up to 80%) of the gallbladder stones are of this type. These are yellow-green colour.
What are the symptoms if you have gallstones?
Usually, gallstones may not cause any signs or symptoms. The pain associated with gallstones may partially depend on their number and size – but no size or combination of their number can exactly indicate whether you will experience pain or your symptoms would become severe. Symptoms usually manifest when complications develop and the pain comes in episodes. However, when gallstone moves out from its place and sits in a duct. It causes a blockage – and you may experience the following signs and symptoms:
- Abdominal pain
- Augmentation of pain after having a meal
- Sudden progressively increasing pain in the upper abdominal portion
- A rapidly increasing pain in the centre of your abdomen
- Nausea or vomiting
- Back pain – especially near the shoulder region between the shoulder blades
- Pain may last for a few minutes to hours
- Bloating, indigestion heartburn and gas
- Other symptoms may include intolerance for greasy or fatty foods
What causes gallstones?
Solidification of bile or cholesterol form stones or solid particles in the gallbladder. This happens when the amount of bilirubin or cholesterol is high. Bile also contains other substances – which may promote the gallstones formation. Individuals who have high levels of bilirubin or blood disease or liver disease can develop gallstones in the gallbladder. Incomplete emptying of the gallbladder may promote the gallstones formation due to the presence of residual bile. People with liver disease may have pigment stones. In a nutshell, the gallstones formation depends on your diet, diseases of the gallbladder or problems within the gallbladder, your genes and weight.
What are the problems you get when you have gallbladder stones?
Gallstones may cause pain after a fatty meal. The pain depends neither on the size of gallstone nor on their numbers. Many people often experience pain when the stone moves out of the gallbladder and obstructs the bile duct – but the stones or a stone that remain within the gallbladder may not cause pain often. However, pain may be felt when the gallbladder responds to a fatty meal.
Gallstones are the most common cause of gallbladder disease. Gallstones can obstruct the outflow of bile from the gallbladder and can even cause obstruction to the outflow of digestive enzymes from the pancreas. Persistent obstruction causes inflammation of the gallbladder (cholecystitis) and also pancreas (pancreatitis). The pressure that build-up due to the contraction of the gallbladder can cause increased pressure, infection and swelling of the gallbladder. The pancreas also gets inflamed persistently along with the gallbladder. This may lead to severe abdominal pain and the condition can cause severe complications and become life-threatening.
What are the risk factors for gallstones formation?
Being overweight or obese is the major risk factor as obese individuals have high cholesterol levels due to which emptying of the gallbladder can become problematic.
- High levels of triglycerides tend to increase the risk of gallstone formation. Diabetic people are at risk owing to this factor.
- Women are at increased risk if they are obese; if they take birth control pills.
- Elderly men, overweight and middle-aged women have risk
- Pregnant women and women who take hormone replacement therapy are at risk
- Cholesterol-lowering drugs can increase the risk
- Quick weight loss is another risk factor
To diagnose gallstones your doctor may order blood tests (to check the signs of infection or obstruction), ultrasound, CT scan or MRCP (magnetic resonance cholangiopancreatography).
Medical therapy is not a permanent cure for gallstones though there are some medicines that can be taken to relieve symptoms and remove stones. All such treatments are temporary. Drugs made from bile acids are used to dissolve gallstones, but the treatment may take months or years and cause mild diarrhea in many people. The treatment is not permanent as the stones can come back after the treatment. Medical therapy is recommended for those who are not fit for surgery.
Surgical removal of the gallbladder (cholecystectomy) is the best treatment irrespective of whether the patient has symptoms or not. Most of the gallbladders are removed by laparoscopic cholecystectomy. The gallbladder can also be removed by open surgery.
Remember! A person can live without a gallbladder. In the absence of the gallbladder, there is no need to change the diet. The bile directly flows into the intestine. This doesn’t cause any problems. There are no problems in the future or in the long-run.
Warning signs of a serious problem include jaundice, persistent pain, and fever. If the pain is severe and associated with fever, sweating, chills, you should seek emergency medical care.
Dr. Venugopal Pareek
MBBS, MS (General Surgery), DNB (Surg. Gastro.), FBMS, FIAGES, FAIS, FMAS
Consultant Surgical Gastroenterologist, Laparoscopic & Bariatric Surgeon