What are gallstones?
The liver produces a digestive fluid called bile which flows into the intestine through the common bile duct. Attached at the side of the common bile duct is a bladder that functions as a reservoir for the bile on its way to the intestine from the liver. This is known as the gallbladder.
The gallbladder is a thin walled bladder about the size of a deflated balloon which holds 3 oz of bile. The gallbladder fills with bile and empties the bile by contracting when the digestive system is stimulated by food. In some patients stones crystallize from the bile within the gallbladder. Gallstones can range in size from as small as a speck to as large as a golf ball. These stones can disrupt the normal flow of bile into the intestines. When this happens problems occur.
What are the symptoms of gallstones?
Blocking the normal flow of bile can cause pain or nausea. This pain is usually in the right upper abdomen. Commonly it radiates to the back. Patients frequently describe the pain being triggered by meals, in particular fatty meals such as fried food. This pain is known as colic and can last for a few minutes to a few hours.
Pain lasting longer than a few hours usually means that the gallstones have created a more serious complication. The gallstones can irritate the pancreas and cause a life threatening condition called pancreatitis. The gallstones can completely block the bile ducts draining from the liver and cause jaundice and cholangitis. If the outlet of the gallbladder itself is blocked an infection can brew inside of the gallbladder causing acute cholecystitis. This is an infection of the gallbladder that can cause the gallbladder to rupture much like a ruptured appendix.
Not everybody that has gallstones has problems. Patients who have symptoms from their gallbladder are at risk for more serious complications. These patients are advised to have their gallbladder removed. Some patients who have no symptoms may also need their gallbladder removed. If you have been found to have gallstones you should have a consultation with a surgeon. There are circumstances where asymptomatic gallstones should be treated. An example of this is a condition called “porcelain gallbladder”. This condition is associated with a high risk of gallbladder cancer.
There are patients who do not have gallstones but have typical gallbladder pain. One theory to explain this is that micro-lithiasis causes the trouble. These gallstones are microscopic in size and are too small to be detected by any study. These patients may be relieved of their symptoms if their gallbladder is removed.
Surgical removal of the gallbladder is the safest and most effective treatment of gallbladder disease. In the early days of modern surgery gallstones were removed and the gallbladder was left intact. It was found that these patients had temporary relief. But the gallstones always came back. This is the problem with all forms of non-surgical treatment of gallstones. Experimentally medications have been used to dissolve gallstones. Intense focused sound waves (called sonic shock therapy) has been used to disintegrate gallstones. These alternative treatments never became mainstream and are no longer available because they were plagued by side-effects and lack of effectiveness.
Our bodies do not need a gallbladder for normal digestion. Patients who have a diseased gallbladder also have a gallbladder that is not functioning normally. Most patients experience no side effects from losing their gallbladder.
Gallbladders are removed with laparoscopic surgery. Very small incisions are made into the abdominal wall and long narrow instruments and a video camera are used to do the surgery after the abdominal cavity has been filled with carbon dioxide gas. The gallbladder is freed from its attachments with the liver and the small duct connecting it to the main duct is tied off and cut. The gas filling the abdomen is then released and the instruments are removed. The small incisions are closed with absorbable suture. The surgery takes about thirty minutes and is preformed under general anesthesia. After the procedure the patient goes to the recovery room for a short while then goes home.