When do I need to have my gallstones removed?

Expert surgeon Ms Avril Chang explains when patients may need their gallstones removed, and what the surgery involves. Gallstones are a relatively common condition - but do you always need to have them removed?

How common are gallstones and what problems do they cause?

Gallstones unfortunately have become more commonly found as people have scans more frequently than they used to. In my opinion, you only need to have them removed if they are causing some trouble. This may come in the form of pain, or infection, so you have fever, shakes, or sweats, or the gallstones fall out of the gallbladder and into the liver ducts, in which case you can become jaundiced, where your eyes turn yellow and your skin turns yellow, or you develop a condition which we call pancreatitis.

When is it necessary to have gallstones removed?

I think the conditions previously mentioned are all what we call absolute indications to have your gallstones removed. If you just have a little bit of pain, or if you've just been found to have stones, by the by, then the best thing to do is probably talk to your GP or get referred to a surgeon and talk to them on an individual basis about whether you really need to have them removed, and what it all involves.

How is gallstone surgery performed?

The surgery to remove the gallbladder involves a general anaesthetic, where you go to sleep fully, and also keyhole, or what we call laparoscopic surgery. Sometimes if you're healthy and it's done early in the day, we can often do it as daycase surgery where you have the operation and then you can go home the same day, later on in the evening. The keyhole surgery usually involves four cuts: one at the belly button, and three more up near the ribcage. The one at the belly button is usually the longest one, but measures usually no more than about half an inch. The three little ones at the ribcage are almost like little stab wounds. Through that we put a camera in, we use long instruments, and we take your gallbladder out and free it off the liver. We put little clips on all the attachments and then we put it into a bag and we pull it out of your belly button. The cuts that you see are usually very nice and if all is well, you can either go home the same day or more commonly go home the next day.

What is the recovery period after gallstone surgery?

Discharge from the hospital is usually the same day or the next day. Sometimes it can be a difficult operation or if there have been any problems during surgery then the hospital stay may just be an extra few days. I would advise most to take off work for two weeks, but during those two weeks you will be able to walk around normally at home and just slowly get back to your normal strength. If you do manual work, like quite physical lifting or a lot of moving about, then I sometimes advise being off work for up to four weeks, because you do spend, you know your body is trying to spend all its energy recovering, and you can get tired quite quickly during the day if you're quite physical. But I would expect that after about four weeks that most people were up to their full strength, if there has been no complications.

Are there any risks associated with gallbladder surgery?

Most people don't feel any different  after the operation apart from the fact that they lose the pain that was associated with the gallstones. Occasionally, people complain of diarrhoea and that can be due to the bowel acids coming into the intestines a bit quicker. If you do get diarrhoea with loose stools, it usually disappears within about 4-6 weeks. In terms of complications, there are some minor things which are more common - every time we do an operation, we always warn about the risk of wound infection and bleeding or bruising around the wound. These complications, however, are quite easy to treat. A wound infection is usually treated with antibiotics, and bruising will usually just go away within 2 weeks. A more serious risk is something like bowel leak, where there is a leakage from where we've tied off the structures connecting the gallbladder to the liver, or where the raw surface that's left from the gallbladder being removed can leak a bit of bile. This is very rare, and if it does occur then it is quite easily treated, but it sometimes may involve another operation. We do the corrective operation through keyhole surgery, where we wash out the bile, then put an extra stitch in, which solves the problem.