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Gallstones

How Are Gallstones Treated?

Last modified: 
13/09/2013 - 10:41

Contributing Author: Guy Slowik FRCS

Some people with gallstones have no symptoms, and may require no treatment. For individuals who are having symptoms, surgery to remove the gallbladder is the most common treatment.

Surgery to Remove the Gallbladder.

Laparoscopic Surgery.

Traditional "Open" Surgery.

Surgery for Blocked Bile Ducts.

Non-surgical Treatment.

Surgery To Remove The Gallbladder

Surgery for gallstone disease is called cholecystectomy. During this procedure, the surgeon removes the gallbladder and the stones inside it. Surgery is a cure for gallbladder disease.

People can live normally without a gallbladder and do not need a change in diet or a special diet. When the gallbladder is removed, the liver continues to make bile. Instead of being stored in the gallbladder, however, the bile flows directly into the small intestine.

There are two ways of removing a diseased gallbladder. One is a newer laparoscopic or "Band-Aid" surgery, in which the surgeon inserts a narrow, long-handled tool, or laparoscope through a small incision in the abdomen. The other is the traditional "open" surgery, in which the surgeon operates through a longer incision in the abdomen.

Nice To Know:

Q. Two months ago, my wife went to the emergency room in the middle of the night with severe abdominal pain. The doctor said it was a gallstone attack, and recommended removal of her gallbladder. She's had no more problems since then. Could the disease have just gone away?

A. Some people do have just one gallbladder attack. But one attack carries about a 70% risk of having another. Your wife may be having symptoms, but confusing them with ordinary indigestion. If tests show that her gallbladder is infected or inflamed, immediate surgery may be necessary. Surgery also may be wise if there are more stones in her gallbladder or she does a lot of foreign travel, which could complicate a sudden need for surgery. Your wife should discuss her own situation with the doctor and find the best approach for her.

Possible complications from gallbladder surgery: The most common and most serious is damage to the bile ducts that results in leakage of bile. It can cause a serious and painful abdominal infection. Infections sometimes can be treated with medication. In other cases, a second operation is needed to repair the leaking duct. These complications are not common.

Laparoscopic Surgery

This "minimally invasive" surgery was introduced in the U.S. in 1988. It now is the standard, or most commonly used, surgery. About 95% of gallbladder surgery is done in this way. It is called "minimally invasive" because the incisions are very small. Patients thus have less pain after surgery, shorter hospital stays, and can resume normal activities sooner. Scars from a laparoscopic cholecystectomy are barely visible.

  • Surgery is done with a general anesthetic. In the operation, the surgeon makes several small incisions in the abdomen. The holes are used to insert instruments to perform the surgery.
  • One incision is used to insert the laparoscope, a pencil-thin device that contains a miniature video camera, power light, and channels for inserting mini-surgical instruments. The camera sends a magnified image to a television monitor, giving the surgeon a clear view of internal organs.
  • The surgeon watches the monitor image while locating the gallbladder, separating it from the liver, ducts, and other nearby structures. Then he uses mini-scissors, clamps, and other tools to detach the gallbladder from the liver and its other attachments. The gallbladder is removed from the body through one of the incisions.
  • Patients receive pain medicine after awakening from the anesthetic. Pain, however, is not severe. Patients usually stay in the hospital only one night. They can start eating a normal diet the day after surgery. Most can resume normal daily activities 3 to 5 days after surgery.

Traditional "Open" Surgery

A traditional cholecystectomy is called "open" surgery because the surgeon removes the gallbladder through a 5-inch to 8-inch incision in the abdomen just below the ribs. Open surgery is done in only about 5% of cholecystectomies in the U.S.

Nice To Know:

Open gallbladder surgery is now used mainly on patients who have gall bladder infections, internal scar tissue from previous abdominal operations, or other problems that make laparoscopic surgery unsuitable.

Sometimes surgeons recognize these problems before the operation, and choose open surgery. In other instances, they encounter the difficulties after starting with the laparoscopic method, and switch to open surgery.

  • Although discomfort from open surgery is more severe, it can be relieved with pain medicine.
  • With open surgery, patients usually must stay in the hospital for 2 to7 days.
  • Patients often have to spend several weeks at home recovering before resuming normal activities.

Surgery For Blocked Bile Ducts

Patients with gallstones lodged in the bile ducts may need two-step surgery. That's because removal of the gallbladder alone would not cure the disease. Rather, it would leave the ducts blocked by the stone, and symptoms would continue.

  • In these cases, the surgeon may use ERCP to remove the gallstones from the duct. The method is similar to ERCP used to diagnose gallbladder disease, but in this case the surgeon uses an instrument on the endoscope to cut the duct. He catches the stone in a tiny basket, and removes it with the endoscope.
  • ERCP may be done before removing the gallbladder, or during the cholecystectomy.

Nice To Know:

Q. When my mom had gallbladder surgery, she stayed in the hospital for a week. It took her weeks at home to get back to normal. The doctor says modern surgery is a lot easier on patients. He says I need to stay just overnight, and can go back to work in about a week. Does that sound right?

A. Today, most gallbladder operations are done with a "Band-Aid" method. It is called "minimally invasive" surgery because it uses small incisions, instead of the 6-inch to 8-inch incision used in the past. The doctor operates through a laparoscope, a pencil thin instrument with a mini-camera. Patients have less discomfort after surgery, heal faster, and resume normal activities sooner

Non-Surgical Treatment

Non-surgical treatments for gallstones are available, but they have disadvantages. The alternative treatments, for instance, are not cures. Gallstones return in about half of people treated. Treatment also may require taking medicine for months or years while symptoms continue, and many trips to the doctor.

Alternative treatments include the following:

  • Oral dissolution therapy involves taking oral drugs to dissolve gallstones. The drugs Chenix (chenodiol) and Actigall (ursodiol) work best for small stones made from cholesterol.

    It takes time for drugs to dissolve gallstones. People often must stay on oral therapy for many months. In addition, treatment does not cure the underlying problem that caused gallstones. Thus when individuals stop taking the medicine, new gallstones may develop. The main side effect of drug therapy is mild diarrhea.

  • Extracorporeal shockwave lithotripsy (ESWL) uses powerful shock waves produced by a medical instrument to break up gallstones. Stones are broken into pieces small enough to pass through the common bile duct and into the small intestine.

    Attacks of biliary colic may occur as the stones pass through the duct. ESWL can be used only for certain types of stones. In addition, it may fail to break up all the stones. In such cases, individuals sometimes can be treated with oral dissolution therapy.

  • Contact dissolution therapy is an experimental treatment being tested for safety and effectiveness. It involves injecting a chemical, methyl tert butyl ether, directly into the gallbladder to dissolve stones. The chemical can dissolve only cholesterol stones.

Nice To Know:

Q. Why should I have my gallbladder removed when non-surgical treatments are available?

A. Non-surgical treatments have plenty of disadvantages. One is that they usually are not a permanent cure. Drugs that dissolve gallstones, for instance, must be taken every day for months or years. They work for only certain kinds of gallstones. If you stop the medicine, gallstones usually start to form again. Shockwave therapy can break gallstones into pieces small enough to pass from the body. But it often doesn't work, and patients may have to take drugs for the rest of their life to keep new stones from forming.

 

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From Andrew Maynard - Chair of the University of Michigan Department of Environmental Health Sciences, with help from David Faulkner - 2013 Master of Public Health graduate.