Gallstones symptoms and treatment

Gallstones are a common ailment that can either remain asymptomatic or cause significant discomfort.

Mr Nicola de'Liguori-Carino, highly experienced consultant general surgeon, provides an in-depth look, discussing the symptoms of gallstones, the available treatment options, and if it’s possible to live without a gallbladder.

What are gallstones, and how are they formed?

Gallstones are hardened deposits that form in the gallbladder, a small organ beneath the liver that stores bile produced by the liver.

Gallstones usually form when there is an imbalance in the substances that make up bile. They can occur when there is too much cholesterol in the bile or when the gallbladder doesn’t empty properly.

What are the symptoms of gallstones?

Gallstones are very common; it’s estimated that 1 in 10 adults in the UK have gallstones. However, most people with gallstones experience no symptoms, and the condition is often discovered incidentally during imaging for other reasons. When symptoms do occur, they may include:

• Sudden pain in the upper right abdomen or the centre of the abdomen, often after eating fatty meals.
• Back pain between the shoulder blades.
• Pain in the right shoulder.
• Nausea or vomiting.
• Other rare symptoms in isolation such as indigestion, anorexia, weight loss.

In severe cases, a gallbladder attack (which occurs when the flow of bile is blocked) can lead to complications such as:

• Biliary colic.
• Acute cholecystitis.
• Acute cholangitis.
• Gallstone pancreatitis.
• Gallstone ileus.

While risk factors, such as being overweight, being female (especially within the reproductive age), being over the age of 40, and being of Caucasian descent have traditionally been associated with a higher likelihood of developing gallstones, these are less predictive in today’s modern world.

Changes in diet and lifestyle, particularly in Western countries, have made gallstones more common across a wider demographic. Therefore, gallstones can affect anyone, regardless of traditional risk factors.

What investigations are needed for gallstone disease?

Before deciding on treatment options, healthcare professionals typically conduct investigations to confirm the presence of gallstones and to evaluate the severity of the condition. These may include:

• Blood tests: Blood tests help assess liver function, the presence of infection, or inflammation.
• Ultrasound: An ultrasound is the most common and effective imaging test to detect gallstones.
• Magnetic resonance cholangiopancreatography (MRCP): An MRCP is a special MRI technique used to visualise the biliary system, aiming to detect stones or any other abnormality affecting it.
• CT scan: A CT scan may be used in certain cases to assess the gallbladder and surrounding organs, especially in cases of acute presentation with gallbladder infections (cholecystitis) or pancreatic inflammation (pancreatitis).
• HIDA (hepatobiliary iminodiacetic acid) scan: A HIDA scan evaluates the dynamic function of the gallbladder and the flow of bile in real-time.
• Endoscopic ultrasound (EUS): An EUS may be used to detect smaller stones, especially in cases where other imaging tests don’t provide conclusive results.

These investigations help guide treatment decisions and ensure that the appropriate intervention is chosen based on the severity and location of the gallstones.

What is the treatment – laparoscopic cholecystectomy?

Laparoscopic cholecystectomy is a minimally invasive (also known as a keyhole) surgical procedure used to remove the gallbladder.

This surgery is typically recommended for patients who have symptomatic gallstones or complications. However, in some cases, even asymptomatic patients may require surgery if the gallstones are deemed to pose a risk for future complications.

During the procedure, 4 small incisions are made in the abdomen and a laparoscope (a thin tube equipped with a camera) is inserted into the body to help guide the surgeon in removing the gallbladder.

What to expect before and during a laparoscopic cholecystectomy?

Before surgery, patients typically undergo imaging tests, blood tests, and a discussion about anaesthetic options. Fasting before the procedure is required. The surgery usually lasts 1 to 2 hours, during which patients are under general anaesthesia. The surgeon uses a laparoscope and other instruments to carefully remove the gallbladder.

What are the benefits and risks/complications of laparoscopic cholecystectomy?

The benefits of laparoscopic cholecystectomy include:

• Less pain and faster recovery compared to open surgery.
• Smaller scars and lower risk of infection.
• Shorter hospital stay and quicker return to normal activities.

However, like with any surgery, there are risks involved, including:

• Bleeding.
• Infection.
• Injury to surrounding organs.
• Complications related to anaesthesia.

Although extremely rare, bile duct injury is one of the more serious complications that can occur during gallbladder surgery. This type of injury may require additional surgical intervention. It’s important that the surgery is performed by an experienced surgeon who is skilled in managing this potential complication.

Recovery time: Duration and expectations

Most patients can return home on the same day as the surgery or after an overnight stay. Full recovery typically takes 1 to 2 weeks, and during this time, patients may experience mild pain or discomfort. It’s recommended to avoid heavy lifting and strenuous activities for at least 6 weeks to allow the body to heal properly. Digestion can also be affected in the first few weeks after surgery and a light diet is recommended.

What are the alternatives to surgery?

If surgery isn’t an option or if patients prefer not to undergo surgery, there are a few alternatives for managing gallstones:

• Dietary changes: In some cases, dietary adjustments may help manage symptoms, though it won’t resolve the underlying issue of the stones.
• Monitoring: Asymptomatic gallstones may be left untreated with regular monitoring for any potential changes or complications.

In conclusion, while gallstones can lead to discomfort and complications, laparoscopic cholecystectomy remains a highly effective treatment option. Always consult with a healthcare professional to discuss your symptoms and determine the best course of treatment.

If you would like to book an appointment with Mr Nicola de'Liguori-Carino, head on over to his Top Doctors profile today.