Gallstones (Part Three)

Blood laboratory tests.

Blood tests are used to check for:

• signs of infection,
• obstruction (blockage),
• pancreatitis or jaundice.

The symptoms of gallstones are the same as those of:

• heart attack,
• appendicitis,
• ulcers,
• irritable bowel syndrome,
• hiatal hernia, pancreatitis, and hepatitis.

Therefore, accurate diagnosis is important.

What is the treatment?

A. Surgical treatment

Surgical removal of the gallbladder is the most common treatment for symptomatic stones. The surgery in this case is called a cholecystectomy.

The most common and preferred method of surgical removal of the gallbladder is laparoscopic cholecystectomy. This type of procedure is performed through three small millimeter incisions in the abdomen, where surgical instruments with a small camera are inserted. Because the muscles of the abdominal wall are not cut, there is less pain and fewer complications during laparoscopic surgery compared to open surgery, where a large abdominal incision is made. The patient only needs to stay in the hospital for one night after this procedure.

If the surgeon discovers obstacles to performing the endoscopic surgery such as; infection or scars from other surgeries, then the procedure is done with open surgery. It is called this because the surgeon will need to make an abdominal incision about 15-17cm to remove the gallbladder. This is surgery that requires the patient to be hospitalized for 2-7 days.

The most common complication of gallbladder surgery is damage to the bile ducts.

If stones are found in the bile duct, then Endoscopic Retrograde Cholangiopancreatography (ERCP) may be performed.

B. Non-surgical treatment

This type of treatment is only used in special cases, e.g.: the patient has serious medical conditions that do not allow the performance of surgery and only in cases of cholesterol stones. Stones usually reform after non-surgical treatment with oral dissolution therapy.

Medications containing bile acid are used to dissolve the stones. Months or even years of treatment may be required to dissolve cholesterol stones. These medications may cause mild diarrhea as a side effect and can slightly increase blood cholesterol levels and liver enzymes.

Direct dissolution therapy.

This experimental procedure involves injecting medications directly into the gallbladder to dissolve the stones.

Methyl tert-butyl ether can break down the stones in 1-3 days but care must be taken as it is a very toxic substance. This procedure remains experimental.

Do people need the gallbladder?

Fortunately, people can live without the gallbladder. Its removal does not require dietary changes.

When the gallbladder is removed, bile flows out of the liver through the hepatic duct into the common bile duct and immediately passes into the small intestine, instead of accumulating in the gallbladder.

However, since bile does not stay in the gallbladder but empties immediately and often into the small intestine, it can cause diarrhea in 1% of people.