Gallstones occur due to chemical imbalances in the gallbladder, including imbalances of chemicals such as cholesterol, phosphate and bile. These imbalances may result in a sludge and, eventually, form gallstones. Such stones may be small or large, with the number of stones formed differing from case to case. Nevertheless, if a stone is left untreated, it will likely increase in size.
Gallstones are more common among women than men, with those aged between 30–50 most at risk. The symptoms are similar to those associated with gastritis, meaning the condition is often not viewed as dangerous, leading many people to purchase their own over-the-counter medication to treat the condition. However, gallstones can be extremely dangerous. If you detect any of the following symptoms, you should seek diagnosis within 1–2 weeks:
If these symptoms are left untreated, they could result in other complications, including cholecystitis, with the gallstone becoming dislodged, leading to a bile duct blockage, or inflamed pancreas. Other symptoms may also present themselves, such as fever, nausea, vomiting, jaundice or darkened urine. In cases where the stomach pain is severe enough to incapacitate the patient, it is essential that the patient be brought to the hospital within 24 hours.
Doctors will initially inquire about a patient’s medical history, carry out a full body checkup and take a sample of blood for analysis. If the patient is found to be at risk of gallstones, an additional ultrasound scan of their abdomen may be necessary, which would require them to fast for at least six hours prior to the procedure. The ultrasound scan is both quick and accurate, providing over 80% more detail when compared with other methods.
Statistics related to the treatment of gallstones show that taking oral medication is not generally effective due to its inability to break up the stones properly. Moreover, when the taking of such medication is discontinued, there is a risk that new stones will begin to form. Shockwave therapy aimed at breaking up the stones has been found to be effective on those located in the bile ducts, although this treatment is not of use when treating stones located in the gallbladder.
Doctors therefore recommend surgical removal of gallstones as an extremely effective form of treatment, especially the laparoscopic cholecystectomy procedure, which is a form of minimally invasive surgery (MIS) that offers much less pain when compared to open forms of abdominal surgery.
However, in patients who suffer from other complications related to gallstones, including a severely swollen gallbladder or a thick membrane surrounding the organ, surgeons will be unable to identify the nearby organs properly, meaning that open abdominal surgery may be the only viable option available.
Currently, the laparoscopic cholecystectomy procedure is preferable as it is, both, highly effective and low risk due to the incision made measuring a mere 0.5 cm, meaning that patients can make a speedy recovery, often returning home within 1–2 days after the procedure.
A laparoscopic cholecystectomy involves making three to four tiny incisions, one near the belly button and two to three under the right side of the rib cage, to enable the insertion of the small camera and device used to survey the gallbladder. These instruments are used to cut the gallbladder, put it in a retrieval bag, and removed. The surgeons will then remove the camera and device and finally complete the procedure by stitching the patient’s wounds.
Although a laparoscopic cholecystectomy has an almost 95% chance of success, patients who have suffered from acute cholecystitis for over three days, as well as those with underlying health conditions, may have a lower chance with laparoscopic surgery being successful. Doctor will therefore carefully consider each case before deciding on whether to operate.
Thus, if you start to experience symptoms that make you suspect gallstones, you must not ignore them or leave them untreated for a prolonged period, as this could reduce your chances of opting for laparoscopic surgery.
The Second Class Honour M.D., Faculty of Medicine Siriraj Hospital, Mahidol University. Faculty of Medicine Siriraj Hospital, Mahidol University , 2002