Gallstones: Exploring causes, risk factors, and surgical treatment

Gallstones, medically termed as cholelithiasis, are hardened deposits that form within the gallbladder.

Here, Mr Sanjay Taribagil, renowned consultant general and upper GI surgeon based in Newcastle-upon-Tyne, offers his expert insight into gallstones, delving into their causes, risk factors, and surgical treatment.

What are gallstones?

Gallstones are very common, affecting over 1 in 10 adults in the UK. Having said that, only a minority of patients actually go on to develop symptoms.

What causes gallstones? Can they be caused by diet?

Gallstones are generally caused by an imbalance in the chemical constitution that makes up bile. Normally, bile is produced in the liver and is then transported down the main bile duct into the small bowel. As the bile travels down the main bile duct, some of it gets stored in the gallbladder, which is a sac-like organ that sits underneath the liver.

The only function of the gallbladder is to store and concentrate bile. When bile is supersaturated with cholesterol, this leads to the formation of tiny crystals or what we call as ‘sludge’ or ‘grovel’ in the gallbladder. These then develop into gallstones.

Gallstones are more common in patients who:

• are obese or overweight
• are female
• are female and are more than 40 years old
• are female and have had multiple pregnancies

Of course, gallstones are associated with a high dietary intake of saturated fat content. However, equally, gallstones can also form when people lose weight very rapidly. For this reason, we generally recommend patients to avoid eating low calorie diets and diets that lead to weight loss very quickly.

To reduce the chances of forming gallstones, patients should try to stay healthy and eat five portions of fruit or vegetables a day, as well as peanuts, cashew and nuts.

How are gallstones treated?

Most patients who have gallstones are asymptomatic, and thus don’t usually need treatment. Treatment, which involves surgery, is only recommended when gallstones start causing symptoms.

The standard surgical treatment for gallstones is a keyhole operation to remove the gallbladder under general anaesthetic, known as laparoscopic cholecystectomy. This procedure is mostly performed as a day-case, where the patient arrives in the morning, has keyhole surgery, and is then discharged home the same day.

During a laparoscopic cholecystectomy, we make three to four small cuts in the tummy. Specialised surgical instruments and a camera are then passed through these cuts, into the body. Looking through the camera, we dissect the gallbladder and disconnect it from the main bile duct. We also separate the gallbladder from the liver, and then remove the gallbladder through one of the cuts. In most cases, patients are able to go home four to six hours after the operation.

As with any surgical procedure, there are small risks involved, including:

• a small risk of bleeding, infection, or injury to the main bile duct
• a small risk of bile leak

If any of these complications occur, then the patient may need to stay in hospital for longer or they may need additional procedures to resolve the issue(s). However, these risks are generally prevented.

Most laparoscopic cholecystectomies are performed successfully using keyhole surgery. In a small number of cases, however, the surgery may need to be changed to a traditional open operation, known as open cholecystectomy. The patient may then need to stay in hospital for three to four days.

What happens if gallstones are left untreated?

If gallstones are left untreated, this can lead to:

• A biliary colic: A biliary colic is a serious condition that causes severe pain in the upper part of the tummy, which can often radiate through to the back or between the shoulder blades. Patients may also feel nauseous or sick at the time.

• Acute cholecystitis: If gallstones block the flow of bile within the gallbladder, then bile can build up and cause inflammation in the gallbladder, resulting in acute cholecystitis. This is a serious condition that causes fever and severe pain in the right side of the tummy, just underneath the right rib cage, which can last for several hours. Patients may need hospitalisation and intravenous antibiotics to treat this.

• Jaundice: Sometimes, tiny gallstones can escape out of the gallbladder and get lost in the main bile duct, resulting in jaundice. This condition causes yellowing of the eyes and/or skin and high-coloured urine or pale stools.

• Acute pancreatitis: Occasionally, blocked gallstones can cause inflammation of the pancreas, resulting in acute pancreatitis. This condition can cause patients to feel quite unwell.

• Bowel obstruction: Very rarely, gallstones (especially large gallstones) that have been present for several years may migrate down an abnormal passage and lodge into the small bowel, resulting in bowel obstruction. Patients may need emergency surgery to treat this.

• ERCP: In some cases, a procedure called an ERCP (endoscopic retrograde cholangiopancreatography) may be required for the removal of gallstones that have escaped out of the gallbladder, passed into the main bile duct, and then gotten lost there.

The risk of gallstones causing gallbladder cancers, however, is exceedingly rare.

How long does it take to fully recover after gallbladder surgery?

With keyhole surgery, recovery is very quick. Usually, the cuts are very tiny and the stitches are dissolvable, and most patients are able to return to their normal routine within a couple of weeks. However, we always recommend to take it very easy for the first few weeks. Additionally, patients should not drive for a week or two, and not fly or take a long journey abroad for the first couple of weeks.

With open surgery, recovery is much longer, probably around four to six weeks.

Can you live a long life without your gallbladder?

Patients can lead a perfectly normal life after the removal of their gallbladder. The liver will continue to produce bile in the same way, after which the bile will continue to pass down through the main bile duct and into the small bowel. Hence, in most patients, the digestion of fat will not get affected.

In some cases, patients may experience a little bit of acid reflux, bile reflux, or diarrhoea, but this is usually self-limiting.

In terms of diet, although we recommend staying on a low-fat diet during the initial phase after the operation, most patients will eventually be able to return to their normal diet.

To schedule an appointment with Mr Sanjay Taribagil, head on over to his Top Doctors profile today.