For the last month or so we’ve been doing a series on gallstones. Gallbladder disease is a common issue as people age and there are many lifestyle factors that can contribute to the risk of and formation of gallstones during your lifetime. But what happens when you get gallstones? Is surgery the only option? Or are there other things you can do for gallstones?
What To Expect Once You Have Gallstones
The most common signs and symptoms that you have gallstones are right upper abdominal pain, nausea, and vomiting (see this post for a full list of signs that you might be having gallstones. Believe it or not surgery isn’t always mandatory if you’re diagnosed with gallstones. In some cases however, gallstones can cause life threatening conditions and are considered a medical emergency that will require immediate surgery.
Gallstone Treatment Option 1:
Do nothing. Yeah, that is your right in regards to your healthcare. You do have the right to refuse any medical treatments. However, that’s not the smartest decision, so don’t do that.
Gallstone Option 2:
Gallstones Without Symptoms:
It’s not uncommon for people to have gallstones without having any symptoms at all. Actually, sometimes people will only find out that they’re having gallstones because they had a CT scan done of their abdomen, for something completely un-related. In these situations, removal of the gallbladder through surgery is generally not recommended. Patient’s are educated on the signs and symptoms of gallstone flare-ups and told to go to the emergency room or contact their primary care physician if any of those signs and symptoms occur.
Gallstone Surgery Options
In the event that you’re going to have surgery you can expect quite a few things: not being able to eat until after your surgery, intravenous fluids, and antibiotics. The surgery is relatively simple as long as you don’t have any major complications from from the gallstones themselves. Sometimes the gallstones will be causing issues just solely in your gallbladder. Other times a stone will have traveled out of the gallbladder and down through the bile duct. Whatever the situation, there are typically a few types of procedures done:
Endoscopic Retrograde Cholangiopancreatography (ERCP):
A what now? An ERCP is a procedure done to remove a gallstone that is stuck somewhere in the bile duct. An ERCP uses an x-ray to look into the bile and pancreatic ducts which extend out from the gallbladder to find a gallstone that’s stuck in the tube system leading out from the gallbladder. The test is done under moderate sedation (not general anesthesia). While you’re sedated the provider will insert a scope down your mouth and into your intestine and bile ducts to try to locate the stone. Contrast dye is injected so the obstruction in the duct can be seen on the x-ray. The provider then makes an attempt to capture a stone in a tiny basket and then is retrieved.
If you’re actively having symptoms from gallstones in your gallbladder that are causing an infection or unbearable pain, your going to need your gallbladder removed. The majority of gallbladder removal cases are done through laparoscopic surgery. In laparoscopic surgery the surgeon makes a few puncture sites in the abdomen: one for a scope and the others for surgical instruments. Using the instruments the surgeon removes the gallbladder from the body and the puncture sites are usually covered with surgical glue and parts within the body are sutured with absorbable sutures.
In the event that your gallstones have caused so much inflammation in your body along with a very bad infection, the surgery is done through what’s called an open cholecystectomy. In these cases the surgeon needs more room to go in and clean out the infected/inflamed areas as well as remove the gallbladder. In this type of surgery the surgeon cuts directly into the abdomen with an incision about six inches long then sutures the inside tissue with absorbable sutures and usually staples the skin closed.
Both types of surgeries are done through general anesthesia.
Does Having Gallstones Always Mean Having Surgery?
No not always. As mentioned above, if gallstones are discovered by accident under some sort of radiology study looking for something else in your abdomen, surgery is only recommended if you have actually been having problems with your gallbladder. Even if you are having gallbladder pain and no infection, you can turn down the option of surgery and monitor for worsening of symptoms and signs of a brewing infection. However, about twenty-five percent of patients with gallstones and no symptoms will develop symptoms within ten years (3). Non-surgical treatments for gallstones include:
Oral Dissolution Therapy:
Medications such as Ursodiol and Chenix are prescribed which contain bile acids. These medications with bile acids help to break down gallstones. These medications really only work on small stones and months and even in some cases, years of treatment are required to dissolve the stones.
Shock Wave Lithotripsy:
Shock waves generated by a machine called a lithotripter help to break the gallstones into smaller pieces. This therapy is sometimes used together with oral dissolution therapy.
Keep in mind, gallstones usually reappear within five years of non-surgical treatment and gallbladder removal is usually recommended at some point. This is generally because of non-modifiable risk factors or because of no change in dietary or physical activity habits.
Now you know what options to expect when you have gallstones, find out what happens after you have your gallbladder removed – is that the end of the story?
2. N.a. “Gallstones.” National Institute of Diabetes and Digestive and Kidney Diseases. November 2013. Web. 18 October 2016.
3. Heuman, D. “Gallstones (Cholelithiasis) Treatment and Management.” Medscape. 14 April 2016. Web. 18 October 2016.