What is the gallbladder? How do gallstones form and how do they cause trouble? What happens when the gallstone stays wedged in the gallbladder or common bile duct outlet? What is ERCP? Do gallstones always need to be treated surgically? Is surgery the only treatment for gallstones? How are gallstones treated? What is laparoscopic cholecystectomy? Is anyone able to have laparoscopic cholecystectomy? What are the surgical risks of laparoscopic cholecystectomy? What is the effect of having the gallbladder removed? What sort of surgeon performs laparoscopic cholecystectomy? Andrew Bowker’s Experience with laparoscopic cholecystectomy What is the gallbladder? The gallbladder is a thin-walled sac of similar dimensions to an un-inflated balloon. It acts as a storage unit for bile, which is made by the liver. The bile is secreted into tubes that join together in the liver and eventually drain via a common main tube (the common bile duct) into the duodenum (intestine), much as the small branches of a tree lead down to the trunk. The gallbladder is a side branch of the common bile duct. It siphons off some of the passing bile, stores it and concentrates it. This concentrated bile is called on by the gut when extra bile is required to digest a fatty meal. How do gallstones form and how do they cause trouble? Gallstones are also known as calculi. It is in the concentrated bile of the gallbladder that they precipitate out and grow. Most of the time they do not cause any problems, but if one becomes wedged in the narrow outlet of the gallbladder, the gallbladder is thrown into spasm as it tries to overcome the obstruction. This typically equates to very severe pain, “worse than labour pains”, to those in the know. In most cases, the pain is relieved when the stone moves away from the gallbladder outlet, back into the main body of the gallbladder, where it has the potential to cause trouble again. Contrary to popular belief, the gallstone is not usually “passed”. However, this can happen, in which case the stone can then lodge in the outlet of the common bile duct, at the point where it enters the duodenum (intestine). In this situation the pain is the same, but if complete blockage occurs, the bile cannot drain down from the liver and obstructive jaundice develops. This is accompanied by dark urine and pale stools. The blood test measuring liver function also becomes markedly deranged. Another digestive gland, the pancreas, drains into the bottom end of the common bile duct. If it becomes obstructed as well, the potentially life-threatening condition of pancreatitis can develop. The offending calculus often passes spontaneously into the gut and the problem is relieved, although it takes much longer for the liver function tests to return to normal. If pancreatitis developes, intensive medical support may be required to aid recovery. Occasionally, pancreatitis is fatal. What happens when the gallstone stays wedged in the gallbladder or common bile duct outlet? Sometimes the gallstone does not roll clear of the gallbladder outlet, in which case pain continues and the gallbladder becomes inflamed. This is called cholecystitis. It can eventually settle spontaneously, but there is potential for the patient to become very unwell and the gallbladder can lose its blood supply – become gangrenous. The likelihood of this occurring is greater in diabetics and the elderly. Early surgery to remove the gallbladder, or at least drain it, is the best option in this situation. Alternatively, if a gallstone remains wedged in the outlet of the common bile duct, jaundice will persist. When infection supervenes, the condition is known as cholangitis. This is dangerous and requires urgent treatment with antibiotics and relief of the obstruction by endoscopic retrograde cholangiopancreatography (ERCP). What is ERCP? Endoscopic retrograde cholangiopancreatography (ERCP) involves the passage of a flexible endoscope (telescope) through the mouth down to where the common bile duct enters the duodenum. The duodenum is the segment of intestine immediately beyond the stomach. Through the endoscope the presence of a gallstone(s) in the common duct can be confirmed and then retrieved from the duct. This procedure is done under sedation, such that, while the patient is able to cooperate, there is usually little or no recollection of the procedure afterwards. Do gallstones always need to be treated surgically? If the gallstones are an incidental finding (e.g. noted on ultrasound while investigating another complaint) and are not causing any symptoms whatsoever, it is perfectly reasonable to leave them alone. Even if they have caused attacks of pain, some people decide not to have anything done about them. However, usually the pain is very unpleasant and sufferers do not wish to repeat the experience. If gallstones are truly asymptomatic, the chance of them causing significant problems is between 25 and 50% for every 10 years they are left. Is surgery the only treatment for gallstones? Some people find that their attacks of pain are very much related to the types of food they eat. If they carefully avoid fatty items in their diet, they can keep out of trouble. Although fatty food causing attacks of pain is a classical association, it is only a minority (about 35%) who have the association. The remainder look to other means of controlling the situation. “Alternative” treatments may be sought, such as lemon juice and olive oil, but there is no good logic behind such treatments. Gallstone pain can be very intermittent, sometimes occurring even years apart, and any apparent success of alternative treatments is likely to relate to this. How are gallstones treated? Some people manage to control their symptoms by being careful with their diet. Unfortunately the majority experience attacks without pattern or warning, although there is a tendency for the pain to come on in the late evening, after the main meal of the day. The only reliable way to deal with the problem is to remove the gallstones, and the gallbladder that produced them i.e., take away the factory as well as the product. In the … Continue reading Gallbladder Surgery