Gallstones are usually formed in the gallbladder. They form because of the composition of the bile. This composition is dependent on hereditary or dietary factors. The presence of gallstones sometimes runs in families. Gallstones occur in about one in 10 adults in our population. They are seen most commonly in females in the forty and fifty year groups. They can occur though in any age group.
The symptoms of gallstones vary tremendously. There may be pain which varies from very mild to severe. The pain (biliary colic) usually lasts up to six hours. If it progresses to inflammation (cholecystitis) then the pain may last for days. The pain is felt in the central upper abdomen, behind the lower breastplate, beneath the rib margin mostly on the right. The pain can radiate round at the back or to the region of the scapula (shoulder blade). Other symptoms may occur such as indigestion, biliousness, nausea or even just a feeling of being unwell. Some people find these symptoms are brought on by eating certain foods i.e., fatty or rich foods.
Gallstones can be present in the gallbladder for many years and cause no symptoms. It is only when people have symptoms do we feel that treatment is needed. Cancer can occur in the gallbladder in association with gallstones. If gallstones pass out from the gallbladder in to the bile duct then these may result in obstruction causing jaundice or pancreatitis.
If treatment is thought necessary then removal of the gallbladder (cholecystectomy) is the most effective treatment. Treatments to flush or dissolve the stones are unproven and usually associated with a high rate of return of the symptoms. Removal of the gallbladder (cholecystectomy) is now mostly performed using the laparoscope or keyhole method. It is not possible to perform this in every person. In a small group of people, less than 5%, it may be found necessary after starting the laparoscopic technique to convert to an open operation. It is not possible to predict in whom that might occur.
In a laparoscopic technique a telescope is passed in to the abdominal cavity usually through the navel. Carbon dioxide gas is used to blow up the abdominal cavity. Several other holes are made through which instruments are passed. At the time of the operation it is common for an x-ray to be performed to examine the bile duct. This bile duct carries the bile down from the liver in to the gut. The gallbladder sits off to the side of that duct and concentrates the bile in between meals. It is adherent to the lower surface of the liver. The x-rays are performed to ensure that no stones are passed out of the gallbladder in to the duct. There may be some safety features associated with outlining the duct at the time of the operation.
If stones are found in the duct then they need to be removed. It can be often carried out laparoscopically. Sometimes an endoscope is passed down through the mouth and stomach some days later to cut the lower end of the duct to release the stones. Open operations are sometimes needed for duct stones. After the arteries are clipped and the small duct joining the gallbladder to the main duct is clipped the gallbladder can be removed.
A drain may be placed in to the abdominal cavity. This would usually be removed the following day.
In most instances the patient will start drinking that evening. Most patients will go home the following day after starting a normal diet. A return to normal activities often occurs within a week.
The complete patient education pamphlet is available from your surgeon.