What are gallstones?
Gallstones form in the gall bladder which is a small "purse-like" organ sitting under the liver in the right side of the upper abdomen. It's main job is to collect bile which is formed in the liver and then release it into the gut, particularly after the ingestion of fatty foods.
Gallstones are extremely common and 10% of women in their 40's are affected.
Signs & Symptoms
Gallstones can cause a number of different problems.
- Silent Gallstones - most gallstones cause no symptoms and require no treatment.
- Biliary Colic and Acute Cholecystitis - most commonly gallstones intermittently block the small duct draining the gall bladder. This causes recurrent attacks of pain in the upper abdomen often radiating to the back and shoulder. These symptoms may be associated with vomiting and are very often precipitated by eating fatty food. The pain can be severe enough to mimic a heart attack. Over time the gall bladder wall becomes thickened and chronically inflammed.
- Acute Cholecystitis - sometimes the stone blocking the cystic duct draining the gall bladder does not disimpact and as a consequence the gall bladder becomes infected. This causes persistent pain lasting more than 24 hours and often associated high temperatures and vomiting. The pain can be severe enough to require admission to hospital and sometimes emergency surgery.
- Acute Pancreatitis and Jaundice - gallstones can sometimes move from the gall bladder into the bile ducts, blocking the flow of bile from the liver, or the duct draining the pancreas. These are both potentially serious conditions which can threaten life, and require treatment.
The diagnosis of gallstones is made by a doctor on the basis of symptoms and signs and further tests. This usually includes ultrasound scanning, which is about 95% accurate in demonstrating stones. Sometimes it is necessary to undergo MRI scans to identify stones in the bile ducts.
- Conservative Treatment - asymptomatic stones ususally require no treatment. Patients suffering mild occasional attacks of pain can sometimes choose to manage their symptoms with lifestyle measures, for instance, avoiding fatty foods.
However, once gallstones become symptomatic, patients often prefer to consider surgery to remove these symptoms as well as the approximately 2% annual risk of suffering the complications above.
- Laparoscopic Cholecystectomy – the "gold standard treatment". This involves usually three or four 5-10mm incisions in the abdominal wall through which the operating intruments and camera are inserted. The gall bladder is disconnected from the surrounding structures and removed intact with its contained gallstones. 30-40% of patients will go home on the same day of surgery and the vast majority of others within 24 hours. Most are ambulant within a few hours of the operation and will have returned to all normal activities within 10-14 days.
- Open Cholecystectomy – Very occasionally if complications arise during keyhole surgery, or it is not possible to complete the operation laparoscopically, an open incision will be required. Open surgery may also be recommended if there is a history of previous abdominal surgery or a history of a bleeding disorder.