Gallstones – Should one undergo surgery?

    Dr. Uday Singh Dadhwal from Bahrain Specialist Hospital tells us more..

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    The gallbladder is a pear shaped organ located under the right side of your rib cage. It stores and concentrates bile that is secreted after a fatty meal and helps in digestion of fat. Gallstones are very common disorder of the gall bladder. There are three types of gallstones: cholesterol, pigment and mixed stones. They cause pain in 80% of cases. Obesity, high-calorie diet and certain medications can increase the secretion of cholesterol and increase the risk of gall-stone formation.

    When to undergo surgery?

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    There are many indications to undergo cholecystectomy or surgical removal of the gall-bladder. They are described below:

    (1) Symptomatic cases: These patients commonly present with right upper abdominal pain, which occurs after intake of fatty food. The fat in the intestine stimulates gall-bladder contraction that results in pain due to presence of chronic inflammation. The pain is usually severe and may last for a few minutes to few hours. It may start at night, waking the patient from sleep. Some patients also present with nausea, vomiting, flatulence, food intolerance, particularly to fats, and some alteration in bowel frequency. Many patients are asymptomatic and are detected incidentally during ultrasound for some other condition. They do not require surgery.

    (2) Complications of gallstones: Whenever a patient develops any complication of gallstones, a surgery may be required. Jaundice is one such complication that occurs if the stone migrates distally. It requires the help of an endoscopist to retrieve the stones. Other complications requiring surgery are empyema of the gall bladder in which there is blockage of gallbladder duct with a stone followed by bacterial infection.

    (3) Gangrene of the gallbladder: Patients with diabetes mellitus are especially prone to this condition. It is a very dangerous condition in which the gallbladder is infected and turns black. This may result in life threatening sepsis. An early diagnosis and surgery can be life-saving.

    (4) Porcelain gallbladder: This occurs due to deposition of calcium in the wall of the gallbladder and is detected on X-ray imaging. This condition is associated with up to 25% risk of cancer whereas in other cases with gallstones the risk in minimal at 0.08%. It is therefore an indication for cholecystectomy.

    (5) Prophylactic cholecystectomy: It should be considered in patients with diabetes mellitus, congenital

    haemolytic anaemia and those undergoing bariatric surgery for morbid obesity, as these patients are at increased risk of complications from gallstones.

    More About Cholecystectomy

    Cholecystectomy is the surgery for removal of the gallbladder including the contained gallstones. It is done by open method in which a large incision is made under the right costal margin. The second method is the laparoscopic surgery in which cholecystectomy is performed through small holes with the help of special instruments. Laparoscopic surgery is the preferred modality worldwide because of the following reasons:

    1. Less post-operative pain

    2. Early return to work

    3. Better cosmetic appearance due to small scars which become invisible after some time.

    In some advanced centres the gall-bladder is removed through a single umbilical incision and is called ‘Single incision laparoscopic surgery’ (SILS).

    Dr. Uday Singh Dadhwal
    (Specialist General Surgery)
    Bahrain Specialist Hospital