• 10Oct

    Gallbladder stone surgery – who needs it?

    The gallbladder is a pear shaped organ located under the liver. It stores and concentrates bile which is required for emulsification and digestion of fat. Gallstones are the most common disease of the biliary system. They are asymptomatic in 80% of cases. They are of three types: cholesterol, pigment and mixed stones. In USA and Europe, 80% are cholesterol or mixed stones, whereas in Asia, 80% are pigment stones. Obesity, high-calorie diets and certain medications can increase the secretion of cholesterol and supersaturate the bile, increasing the risk of gall-stone formation.


    Indications for gallbladder stone surgery

    Symptomatic gallstones – these patients commonly present with right upper abdominal pain, which occurs especially after intake of fatty meals. The fat in the intestine stimulates the gallbladder to contract so that digestion can occur. It results in pain due to contraction of chronically inflamed (swollen) gallbladder. The pain may radiate to the chest mimicking as acute myocardial infarction (heart attack). The pain is usually severe and may last for a few minutes to few hours. The pain may start at night, waking the patient from sleep. Some patients also present with features of nausea, vomiting, flatulence, food intolerance, particularly to fats, and some alteration in bowel frequency. Many patients are asymptomatic and are detected incidentally during ultrasound for some other condition. They do not require surgery. Also, the risk of cancer in patients with gallstones is very remote (0.08%).

    In some cases patients with gallbladders needs to undergo a surgery

    In some cases patients with gallbladders needs to undergo a surgery

    Complications of gallstones – whenever a patient develops any complication of gallstones, a surgery may be required to get relief. Jaundice may occur if the stone migrates distally and then it will require the help of endoscopist to retrieve the stones. If that fails then a bigger surgery in comparison to cholecystectomy (surgical removal of gallstones) is indicated. The other complications requiring surgery are empyema of the gall bladder (blockage of gallbladder duct with a stone followed by bacterial infection resulting in a pus filled gall bladder), mucocele (an obstructed gallbladder filled with mucus) and perforation of the gallbladder (hole in the gall bladder with leakage of its contents including bile and stones). Due to perforation of the gallbladder, a large stone may pass into the intestine and can cause intestinal obstruction which may require an emergency surgery.

    Gangrene of the gallbladder – Patients with diabetes mellitus are especially prone to this condition. It is a very high risk condition in which the gallbladder is infected and turns black. An early diagnosis and surgery can be life-saving.

    Porcelain gallbladder – This occurs due to deposition of calcium in the wall of the gallbladder and is detected on X-ray imaging. This condition is associated with up to 25% risk of cancer whereas in other cases with gallstones the risk in minimal at 0.08%. It is therefore an indication for cholecystectomy.

    Prophylactic cholecystectomy – It should be considered in patients with diabetes mellitus, congenital haemolytic anaemia and those undergoing bariatric surgery for morbid obesity, as these patients are at increased risk of complications from gallstones.

    Cholecystectomy

    Cholecystectomy is the surgery for removal of the gallbladder including the contained gallstones. It is done by open method (large incision under the right costal margin) or through laparoscopic surgery (keyhole surgery). Laparoscopic cholecystectomy is the preferred modality of surgery worldwide because of the following reasons:

    • Less post-operative pain
    • Early return to work
    • Better cosmetic appearance due to small scars which may become invisible after some time

    In some advanced centers the gallbladder is removed through a single umbilical incision and is called ‘Single incision laparoscopic surgery’ (SILS). The gallbladder has also been removed through mouth or vagina by the surgical method of ‘Natural orifice surgery’ (NOS). These new methods are still under development and are not done worldwide.

    Anna L.

    It’s all about health!
    I have academic background in drugs related Chemical Technology, as well as extensive professional experience in pharma and medical companies. My main area of interest is everyday life medicine. The goal of my articles is to give people informative answers to the questions that bother them, to dispel doubts and some common misbeliefs and also to inspire everyone to keep healthy lifestyle.

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