There are approximately 40,000 patients each year that require a gallbladder removal operation due to gallstone-associated problems in England. Not all patients who have gallstones develop symptoms due to them. 20% may never develop any symptoms and live through their life without requiring any treatment.
Types of gallstones
Gallstones are of three different types:
- cholesterol stones
- pigment stones
- mixed stones.
There is no direct association between the type of stones and the symptoms that they will produce. Cholesterol stones are usually large and fewer in number and are more likely to remain asymptomatic. Whilst multiple and small stones are more likely to give rise to symptoms and complications such as jaundice and pancreatitis.
It is not fully understood why gallstones are formed. It is believed that stones are formed due to the imbalance in the constituents of the bile. This results in the precipitation of constituents and eventual stone formation. Why this happens and why in some and not others is not fully understood.
What are the symptoms of gallstones?
The most common presentation of gallstones is abdominal pain. These pains start suddenly and are severe and colicky in nature and often stated as worse than labour pain. The pain starts in the epigastrium or in the right side of the upper abdomen, radiates to the back and in the region of the right scapula.
It is more likely to occur after a large meal and usually last for 2 to 4 hours. These pains are called biliary colic and once resolved the patient usually feels perfectly fine. Once a patient with gallstones has had an attack of pain recurrent attacks are more likely.
The second most common presentation is acute cholecystitis. UK Hospital Episode Statistics' data for the years 2003-2005 showed that 25,743 patients were admitted as an emergency with acute gallbladder disease during that period. There is inflammation of the gall bladder due to the blockage of cystic duct from the stones. Patients feel ill with abdominal pain, nausea vomiting and fever. The majority of patients require hospital care with intravenous antibiotics and painkillers. Once acute cholecystitis has occurred the patient requires an operation to remove the gallbladder either urgently during the same admission or at a later date with a planned operation. While waiting for an operation there is a risk of further acute attack. The chance of this happening could be reduced by avoiding fatty meals and smoking.
Other less common presentations of gallstones are jaundice and pancreatitis. Jaundice occurs due to the blockage of the bile duct by the stones that pass in to the bile duct from the gall bladder through the cystic duct. Pancreatitis is potentially a serious condition that can make patients very ill and could be life threatening.
How to diagnose gallstones?
The best way to confirm or exclude the presence of gallstones is the examination of the gallbladder and bile duct with an ultra sound machine. In expert hands an ultra sound examination is highly sensitive in confirming or excluding gallstone disease. Sometimes in difficult cases especially in obese patients other investigations like MR or CT scans are carried out to help with the diagnosis.
Treatment of gallstones
The best treatment for symptomatic gallstones is the removal of the gallbladder along with gallstones by surgical operation. In the majority of patients the removal of the gallbladder results in no side effects. Up to 5% of patients may experience abdominal bloating and diarrhoea. This usually settles in a few months and rarely anyone requires anti diarrhoea medication and bile salts.
The operation for the removal of the gallbladder is done by keyhole technique and is called Laparoscopic Cholecystectomy. For this operation patients require a general anaesthesia, and therefore only patients who are fit for anaesthesia can have the surgery. The operation is performed through four incisions of up to one centimetre in size. This can be done either as a day case or with an overnight stay in the hospital. Recovery from the operation is quick and majority of patients can get back to day to day activities, including driving, within two weeks of the operation. Two per cent of patients may require an open cholecystectomy that will result in a longer stay in the hospital and prolonged recovery time of up to 6 to 8 weeks. Like any operation, gallbladder surgery caries potential risks. One serious complication is injury to the bile duct. The incidence of this is very low.
I have been performing laparoscopic cholecystectomies for over 15 years and have carried out over a thousand operations, with only one bile duct injury that was successfully treated.
Frequently Asked Questions
Who can have this operation?
If patient has gallstones that are giving symptoms then they can have the operation. Operation requires the Patient to be put to sleep. The patient therefore has to be fit for General Anesthesia.
Is the operation done by Keyhole?
In 98% of cases the operation is done by keyhole.
How long will I be in hospital?
The majority of patients go home within the same day or within 24 hour of the operation.
Will there be a lot of pain after the operation?
Pain is minimum after Keyhole operations however you will be given painkillers to reduce any discomfort. The majority of patients’ pain will be controlled with minimal medication within one to two days.
How long will it be before I can drive again?
The patient is usually advised not to drive within the first week. If pain and discomfort is not a problem in the second week of the operation then you should be able to drive.
When can I return to work?
In most cases you should be able to return to work within 3 - 4 weeks after the operation. If work requires heavy duty then longer rest may be required.
Would I have any problems after the operation if I have no Gall Bladder?
If the patient’s gallbladder has stones it is most likely not working. Most patients after the removal of gallbladder feel better as their previous symptoms have disappeared. There are usually no problems with eating and no other symptoms due to not having a gallbladder. In short you won’t miss your gallbladder! In 5% of patients may experience some abdominal bloating and diarrhea after the operation. In the majority of cases these symptoms usually settle within 2 – 3 months. In a small number of cases these symptoms may persist and the patient may require medication to control this.