When is surgery required for gallbladder stones?

If definitive treatment is required for symptomatic gallbladder stones, it may be necessary to remove the gallbladder, a small, pear-shaped organ located close to the liver. In this informative article, highly respected consultant general and colorectal surgeon Mr Matthew Tutton gives an expert guide to gallbladder removal surgery, known as cholecystectomy, and details when intervention is required in cases of gallbladder stones.

When is surgery required for gallbladder stones?

Problems with the gallbladder are very common and many people may experience episodes of pain or discomfort, normally up on the right side and can be associated with vomiting. These symptoms may recur over time. In severe cases, people may have quite serious symptoms and inflammation meaning they need to visit a hospital.

Gallbladder stones themselves are very common and if we happened to scan a random cross section of people, we would often find incidental gallstones. However, when they start becoming symptomatic they tend to cause recurrent issues. Once this occurs a treatment plan should be formulated.

For people who have very minor symptoms or who wish to avoid surgery, we can offer conservative (non-surgical) measures for gallstones. We normally start with a low fat diet as the gallbladder stores bile and when we eat it contracts and expels bile, which helps to digest fatty foods.

Although effective for some patients, a low fat diet is not a definitive treatment option. In patients with persistent and severe symptoms, surgery to remove the gallbladder is the most effective form of treatment.

How is gallbladder removal surgery performed?

Gallbladder surgery is a very common procedure, which can nearly always be performed using a keyhole method (laparoscopically). It is performed under general anaesthetic and usually four small incisions are made in the tummy - just a centimetre or so in size. Using key-hole equipment, we go inside the tummy and use gas to distend the tummy so we can see the gallbladder.

In cases of gallstones, we remove the whole gallbladder rather than just the stones themselves. We look at the tubes connecting the gallbladder to the bile ducts which drain bile into the bowel. We carefully identify those and usually perform a dye test into those tubes to show the anatomy of the bile ducts. This helps to confirm that there aren’t any hidden stones in these ducts, which may go on to cause future problems.

After that, we put clips on the tube which drains bile from the gallbladder and its blood supply and then divide them so the gallbladder can be removed from the liver itself. The gallbladder is then placed in a little bag which is removed, typically via the belly button. The wounds are then closed and the procedure is complete.

Gallbladder removal surgery can be performed as a day-case operation although some people take a little bit longer to recover or may have other medical issues that require an overnight stay. Most people, however, recover quite quickly and spend a couple of weeks recovering at home.

What happens if a gallbladder that needs to be removed is not treated?

Normally, if people start experiencing problems with their gallbladder and trouble with gallstones, it indicates they will go on to experience recurrent attacks. If these issues are not dealt with, there are risks of more severe attacks which could result in hospital admission and antibiotics to treat an infection.

In rare cases, pancreatitis can occur as a complication of gallstones. This is an inflammation of the pancreas, an organ just behind the stomach, and can be quite severe and may cause serious issues. Therefore, any patient with recurrent symptoms or severe problems from the gallbladder is very much recommended to explore their surgical options.

Are there non-surgical ways to treat gallbladder-related issues?

For people looking to avoid surgery, perhaps because they are at higher risk of general complications due to other medical issues, there is the option to follow a low fat diet in order to reduce the risk of developing issues as much as possible. In order to maximise the chances of the diet being effective, it should be maintained long term.

Some types of medicines which try to dissolve the gallstones within the gallbladder can also be tried. In most cases, however, they are not very effective and unfortunately, gallstones reform and cause problems.

These conservative measures are not effective in every case and recurrent symptoms may occur. Therefore, if possible, re-exploring the idea of surgery may be an option going forward if circumstances change.

Mr Tutton is one of the UK’s leading consultant general and colorectal surgeons. If you are concerned about gallstones and wish schedule an appointment with Mr Tutton, you can do so by visiting his Top Doctors profile.