How to treat gallstones

In this article, a leading consultant gastroenterological surgeon explains how gallstones are caused and how they are treated.

What are gallstones?

Gallstones are hard, pebble-like balls that can range from the size of a grain of sand or as large as a coin. They form in the gallbladder, is an organ in the abdomen that is used to store and release the bile that is used to break down fats in the digestive system. The stones don’t always necessitate medical intervention, but in some cases, surgery will be required to remove the entire gallbladder – this will not affect the gastrointestinal function too much, as the liver can also create and store bile.

The gallstones are made of excess cholesterol or bilirubin, and there will normally be more than one at a time.

Gallstones are not always accompanied by symptoms, but the main symptom that can arise with gallstones is abdominal pain (biliary colic). This is when a gallstone becomes stuck, such as in the cystic duct (cholecystitis), or in the pancreatic duct which causes an inflammation of the pancreas (pancreatitis). The pain will start in the upper-right part of the abdomen and then may travel to the shoulder. Other complications include nausea, fever, and the skin adopting a yellow-tinged hue (jaundice).

How are gallstones treated?

In the case of complications like biliary colic, surgery will be considered to remove the gallbladder entirely. This procedure is called a cholecystectomy, and it can be performed openly or laparoscopically, which is more common. Laparoscopy is preferred because it is minimally invasive, which means less blood loss and a shorter recovery time for the patient, but open techniques may be required for more complex cases.

For a laparoscopic cholecystectomy, the surgeon will make small incisions in the abdomen around the belly button. Using instruments and the long, thin tube with a camera and a light at the end called a laparoscope, they will access the organs via incisions to separate the gallbladder from the liver, bile ducts, and surrounding blood vessels. The incisions are sealed with sutures, surgical staples, or surgical tape, and dressed.

What happens after gallbladder surgery?

The procedure is short and performed under a general anaesthetic. The patient will be monitored until the anaesthesia fully wears off and they are lucid and able to walk around. They may be prescribed painkillers to manage expected the discomfort. Afterwards, the patient will need to follow a low-fat diet as the body adjusts to the absence of the gallbladder, and they might struggle initially with bloating, flatulence, and diarrhoea, but this should subside after a few weeks.

The recovery time for an open surgery can take up to eight weeks, but for a laparoscopic procedure, it could be as little two weeks. Patients are advised to avoid physically strenuous activities whilst they heal, but they should be able to return to work or school within a few weeks.