Nick has years of experience helping patients to achieve a diagnosis, including referrals for diagnostic imaging.
He has performed multiple laparoscopic cholecystectomies (keyhole gallbladder removals), always putting patient care and wellbeing first while communicating with them every step of the way towards surgery.
What are gallstones?
Gallstones form in the gallbladder, ranging in size from miniscule to the size of a ping-pong ball. A patient can have a single large stone, lots of tiny stones, or both, and they can cause sudden pain in the abdomen.
The gallbladder is a small purse-like organ that sits under the liver in the right side of the upper abdomen. Its main job is to collect bile, formed in the liver, before releasing it into the gut, particularly after eating fatty foods.
Gallstones are extremely common, affecting 10% of women in their 40’s.
Signs and symptoms
Silent Gallstones
Most gallstones don’t cause any symptoms and won’t need treatment.
However, those that do can cause a number of different problems:
Biliary Colic and Acute Cholecystitis
It’s common for gallstones to intermittently block the small duct draining the gallbladder, causing recurrent attacks of pain in the upper abdomen and often radiating to the back and shoulder. These symptoms may be associated with vomiting, generally precipitated by eating fatty foods, and with pain severe enough to mimic a heart attack. Over time, the gallbladder wall will become thickened and chronically inflamed.
Acute Cholecystitis
The cystic duct drains the gallbladder. If a gallstone blocks it and gets stuck there, the gallbladder will eventually become infected. This causes persistent pain, often with high temperatures and vomiting, and lasts more than 24 hours. The pain can be severe enough to require admission to hospital and sometimes emergency surgery.
Acute Pancreatitis
Gallstones sometimes move from the gallbladder into the duct draining the pancreas. Acute pancreatitis, caused by gallstones, often develops after a large meal or following significant alcohol consumption with pain developing six to twelve hours after drinking.
Severe cases can cause major complications and be life-threatening.
Other symptoms of acute pancreatitis include nausea, vomiting, diarrhoea, indigestion, a high temperature, jaundice (yellowing of the skin and the whites of the eyes) and a tender or swollen abdomen.
Diagnosis
A diagnosis of gallstones is made by a doctor on the basis of signs, symptoms and further tests. This usually includes ultrasound scanning, which is about 95% accurate in demonstrating stones. It may be necessary to undergo MRI scans to identify stones in the bile ducts.
Treatment options
Conservative treatment
Asymptomatic stones don’t usually require treatment; patients suffering occasional mild pain can manage their symptoms with lifestyle changes such as avoiding fatty foods.
However, once gallstones become symptomatic, surgery is an effective option. It can remove symptoms as well as the approximately 2% annual risk of suffering complications, as described above.
Laparoscopic Cholecystectomy
This is the gold standard of treatment, usually involving three or four 5–10 mm incisions in the abdominal wall through which the operating instruments and camera are inserted. The gallbladder is disconnected from the surrounding structures and removed intact with its gallstones still inside.
30-40% of patients go home on the same day and the vast majority within 24 hours. Most are able to walk around within a few hours of the operation, returning to normal activities within 10–14 days.
Open Cholecystectomy
Very occasionally, an open incision is made if there are complications during keyhole surgery or it’s not possible to complete the operation laparoscopically. Open surgery may also be recommended if there’s a history of abdominal surgery or a bleeding disorder.
Complications
Following modern laparoscopic cholecystectomy, complications are unusual. Nonetheless as is the case with all intraabdominal procedures these can occur.
Potentially these can include
- Bile duct injury (<0.5%)
- Bile leak from adherent duct (approximately 1%)
- Bleeding
- Visceral injury
- Wound infection