Gallstones are very common, with more than 60,000 people having their gallbladder removed each year. With advances in modern medicine, some patients are surprised that gallbladder surgery is still the main treatment for gallstones that cause symptoms.
Surgery may be the only way to get gallstones out of the body, but the good news is that having a laparoscopic cholecystectomy (gallbladder removal) allows a much quicker recovery than open gallbladder surgery.
The importance of an accurate diagnosis
“Abdominal pain and nausea/vomiting can be a sign of many different conditions from food poisoning to liver disease. Patients with regular attacks of these symptoms need to be investigated for gallstones. An ultrasound scan and liver function blood tests can be arranged. If gallstones are present, a cholangiography followed by surgery to remove the gallbladder will then be required.”
Mr Jonathan Wilson offers laparoscopic gallbladder surgery in his NHS practice and privately at The London Clinic.
Symptoms of gallstones
When gallstones become trapped in the bile duct, this can cause irritation and inflammation in the duct itself, which can spread to the gallbladder.
This may cause:
What is biliary colic?
Biliary colic can be treated using painkillers, and if the attacks are fairly infrequent and continue to be mild, you may not need further treatment. Eating a diet that is fairly low in fat and eating small meals can help. If the attacks become more frequent, then your surgeon may advise surgery.
- Intense upper abdominal colicky pain (often worse in the right upper quadrant of the abdomen under the ribcage). This is known as biliary colic and is often brought on by eating fatty foods. The pain is usually temporary and settles after taking painkillers, although this can take anything from a few minutes to several hours. If biliary colic does not settle quickly, the gallbladder can become inflamed. The result is cholecystitis, which results in continuous right upper quadrant pain, fever and dehydration.
- Nausea and vomiting.
- Jaundice, where the skin and whites of the eyes turn yellow because the body cannot get rid of bilirubin and other pigments that are normally secreted into bile.
- Pancreatitis. The pancreas is a digestive organ situated close to the gallbladder and it can be irritated by gallstones passing down the bile duct. In a small proportion of patients, pancreatitis can be severe and life-threatening.
Intermittent symptoms and gallstone disease
Some people with gallstones do get symptoms, but these can be quite mild and they only occur now and again.
Asymptomatic gallstones
If you have gallstones but they don’t cause you any problems, they are said to be asymptomatic. They may be discovered when you have an X-ray or ultrasound scan for something else. Once your doctor knows that you have gallstones, you will be monitored and made aware of the symptoms that can arise, but you won’t need treatment. It may be difficult not to worry at first, but as long as you are well and healthy, there is no need to be concerned.
Medical treatment for gallstones
Although there are many mythical treatments that are said to cure gallstones, none work. Medical treatments have been tried in the past but are ineffective. The drug ursodeoxycholic acid has been used historically to try and dissolve gallstones, but is no longer considered part of modern gallstone management due to its ineffectiveness.
When gallbladder surgery is necessary
You will need gallbladder surgery if you start having frequent attacks of biliary colic, with hours of intense pain and vomiting, and which start to disrupt your normal activities. Once your quality of life begins to suffer, your doctor will recommend a cholecystectomy. Without an operation, your health will continue to deteriorate.
In extremely rare situations, some stones can be treated using lithotripsy, a treatment commonly used for kidney stones. Ultrasound is used to break up the stones within the gallbladder and to convert them into fragments small enough to pass through the bile duct and out into the intestine safely.
Fewer than one in ten people with gallstones find that their condition can be managed by medical treatment.
Imaging and diagnostics used before gallbladder surgery
When your symptoms and history suggest to your GP that you may have gallstones, he or she will start by examining the abdomen. If the pain is severe, they may carry out a test for Murphy’s sign. You will be asked to breathe in and then your GP will press on your abdomen, just over your gallbladder. If this is painful, it is likely that your gallbladder is inflamed.
The next steps are:
- Blood tests.
- An ultrasound scan to confirm that your gallbladder contains gallstones.
- Referral to a Consultant General Surgeon with laparoscopic skills to assess if you need surgery, either planned or urgent.
- Some patients with gallstones will require a cholangiopancreatography, a type of X-ray study of bile ducts and gallbladder traditionally performed during a gastroscopy (endoscopy with ERCP), but increasingly the same information can be obtained from a non-invasive MRI scan (MRCP).