What are gallstones?

The gallbladder is a small organ that lies beneath the liver. The primary function of the gallbladder is to concentrate and store bile, a very useful digestive fluid. Bile is required to digest and absorb fatty food in the small intestine. As a meal containing fat is consumed, the gallbladder contracts and empties into the bowel where is mixed and helps to digest food.

Gallstones are solid, stone like structures that form inside the gallbladder. Many people in London develop gallstones and look for efficient treatments. Gallstones form in the gallbladder as a result of imbalances in bile composition.

Types of gallstones

There are two main types of stones; cholesterol or pigment. Cholesterol stones are a lot more common than pigment stones.

Cholesterol gallstones consist mainly of cholesterol, accounting for more than 80% of gallstones according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Pigment gallstones are made of bilirubin, as a by-product of conditions like liver diseases and hemolytic disorders.

Who gets gallstones?

what are the risk factors ?

There are specific traits that create the proper context for gallstones to develop. Certain individuals are vulnerable to this condition. We should mention that women develop gallstones more than men.

Gallstones becomes more common with age, especially after 40 years of old
They can run in the family
Pregnant women – enhanced estrogen levels can contribute to the development of gallstones
Obesity – A common risk factor as a result of
Rapid weight loss including surgical interventions for weight loss
Diabetes – Patients with diabetes are far more likely to develop gallstones
Sickle cell disease- there patients are more likely to develop pigment stones due to high bilirubin production

What are the symptoms of gallstones?

Most people do not get any symptoms from gallstones. Even though they are asymptomatic, gallstones come to view incidentally on scans performed for other reasons. These do not need to be treated unless they become symptomatic. When symptomatic the signs to look out for include some of the following.

Gallstones symptoms to look for:

Abdominal pain on the right upper abdomen just below the ribs. This pain can also be in the center of the upper abdomen or in the right chest and is often confused with a heart attack. This particular type of pain caused by gallstones has the name biliary colic. The pain levels varies from one patient to the next.
May get right shoulder or back pain
Nausea and or vomiting, common after eating fatty foods

What are the complications associated with gallstones?

Symptomatic gallstones need immediate medical evaluation. Gallstones can present serious complication, which may include one of the following:

Acute cholecystitis which is infection and inflammation of the gallbladder. This occurs when a stone blocks the gallbladder. The pain with cholecystitis is usually constant and is often associated with a fever. The treatment of cholecystitis is antibiotic, fluids and painkillers. If this is not treated the gallbladder can burst and the patient can become very unwell. A serious condition implies dedicated medical treatment and attention.

Choledocholithiasis appears when the stones leave the gallbladder and enter the ducts of the liver or the pancreas. This can result in:

Jaundice which is a yellow discolouration of the skin and eyes
Cholangitis which is when a stone blocks the main duct of the liver resulting in severe infection. The patient experiences severe pain, jaundice and fever. This stones occasionally can pass through by itself but often the patient requires a procedure for this to be removed; endoscopic retrograde cholangiopancreatography also known as an ERCP.
Pancreatitis which is when of the stones blocks the duct of the pancreas leading to inflammation of the pancreas

How are gallstones diagnosed?

The commonest way to identify stones is with an ultrasound scan of the abdomen. Often they are also picked up on other imaging such as a CT or an MRI scan but this is less common.

Gallstones ultrasound

Gallstones ultrasound – the most popular and accurate imaging method for diagnosing the condition;

CT scan or MRI

CT scan or MRI is on occasion used if the doctor suspects other complications;

HIDA Scan

HIDA Scan (Hepatobiliary Iminodiacetic Acid Scan) will evaluate the gallbladder function and detect any blockages.

What are the consequences of not undergoing treatment?

As mentioned above patients may develop complications if they do not undergo treatment. Such complications may include one or more of the following:

Pain in the right upper abdomen also known as biliary colic;
Infection of the gallbladder, known as cholecystitis;
Stones that have move out of the gallbladder into the ducts of the liver and the pancreas leading to cholangitis and pancreatitis;
Gallbladder perforation which is a rare condition, with life-threatening

What are the treatment options?

Wait and watch

Doctors evaluate the stage of the condition and determine the right course of action. This is the likely course of action when the stones are asymptomatic.

Non-surgical treatment

Non-surgical treatment includes a medication known as ursodeoxycholic acid that can help to dissolve gallstones. It can usually take a few months for symptoms to settle but a few years for the stones to dissolve completely.

Shock wave therapy

Shock wave therapy although usually used for kidney stones and rarely used for gallstones is a known treatment. It uses shock waves to break down gallstones into a finer consistency so it can be mixed in bile. Shock wave lithotripsy is rarely for gallstones.

Extraction of stones

Extraction of stones through the skin, although rarely performed can be done. This involves inserting a tube though the skin into the gallbladder, removing the bile and gradually increasing the size of the tube to remove the stones.

Extraction of stones

The disadvantage of undergoing non-surgical management is that they are rarely used and hold the risk of recurrence of gallstones.

Surgical intervention is an operation that removes the gallbladder known as a cholecystectomy. This is a common operation in the surgical world.

How is procedure performed?

Cholecystectomy or removal of the gallbladder can either be performed as a key hole procedure or with a larger incision. A key hole operation also known as a laparoscopic cholecystectomy involved making four small cuts on the abdomen and inserting a camera to visualize the gallbladder and removing the gallbladder through the small cuts. For symptomatic gallstones, cholecystectomy is an efficient solution, with good results.

Types of cholecystectomy for symptomatic gallstones:

Laparoscopic cholecystectomy is a minimally invasive, performed with attention through small incisions. The advantages are clear for patients: shorter hospital stay and quicker recovery time. Most patients prefer this particular type of cholecystectomy.

Open cholecystectomy implies making a larger incision, present in more complicated cases. It also comes with a longer recovery period.

What are the risks of gallstones surgery?

Infection and or bleeding
Pain
Intra or post procedure bleeding
Damage to other organs within the abdomen including the bowel, liver, stomach etc
Bowel perforation
Damage to the ducts of the liver known as the bile duct
Damage to the bile duct can lead to a bile leak, need for open conversion and drain insertion
Conversion to open surgery
Need for endoscopy post-surgery if there is concern of a leak or further stones
Complications related to a prolonged operation/anaesthetic including clots in the legs, lungs, brain or heart.

In the long-term, patients must be warned about the risk of loose stools and bloating. Doctors monitor the patient during and after the operation to limit the appearance of complications and intervene swiftly if needed.

Still, most of these symptoms are usually mild and do not need any intervention.

How long will I be in hospital and what is the recovery period and follow up?

After the gallstones surgery, recovery time varies from one individual to the next. After surgery the course of recovery is as follows:

Tend to go home the same evening or the next day if the operation was uncomplicated
Can eat and drink as tolerated immediately after the operation. One mention: patients need to introduce gradually fatty foods in their diets.
2 weeks before going back to work
Absorbable stitches are usually used for the skin
Physical restrictions: no heavy lifting or strenuous activity for 6 weeks
Post-operation evaluation: Patients will be followed up 4-6 weeks after surgery

Book an appointment with Mr. Ash Rohatgi in London!

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As an experienced upper gastrointestinal, laparoscopic and general surgeon with availability in London, Mr. Ash Rohatgi provides expert care to aid your ailment. Whether you are looking for medical advice, diagnosis, second opinion or efficient treatment, booking an appointment is the logical step towards a healthier version of yourself.