What are gallstones and how are they treated?

Are you experiencing abdominal pain and wondering why? It may be that gallstones are to blame. Mr Max Almond, Consultant Sarcoma and Upper Gastrointestinal Surgeon at BMI The Priory Hospital and BMI The Edgbaston Hospital, shares advice on this common problem.

It’s thought that as many as one in seven people have gallstones1

What are gallstones and are they serious?

Gallstones are stones that form in the gallbladder. They’re usually made of cholesterol and calcium and they vary from small to large in size.

The gallbladder is a small organ that sits in the upper part of your abdomen, just below your liver.

In many cases, gallstones do not cause any symptoms and do not need to be treated. However, some gallstones can cause severe pain or even infections. Occasionally they can even lead to other serious conditions including pancreatitis and jaundice (yellowing of the eyes and skin).2

Why do people develop gallstones?

It’s thought that gallstones are caused by an imbalance in the bile in your gallbladder.

There are a few known risk factors for developing gallstones, including:

  • Being overweight or obese
  • Being 40 or over (they become more likely the older you are)
  • Being female (women are more likely to develop gallstones, especially if you’ve had children)2

I’ve been getting upper abdominal pains: what else could it be?

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Gallstones are one of the most common causes of abdominal pain. If I suspect a patient has gallstones, I always request an ultrasound scan of their abdomen to check.

I also arrange some blood tests to ensure that the gallstones have not blocked the bile duct that drains from the liver.

In some cases, other conditions can mimic the symptoms of gallstones. For example, inflammation in the stomach can cause very similar pains and may lead to stomach ulcers.

If the abdominal ultrasound scan does not reveal gallstones, I usually recommend further investigations, such as a camera test into the stomach or a CT scan, to find the cause.

Will gallstones go away if I wait long enough?

No, but don’t worry. Not everyone with gallstones will need an operation.

If your gallstones were picked up by chance while you were being examined for something else, it’s likely you won’t need treatment. You only need treatment if they’re painful or causing complications.2

If my patients are in pain from gallstones, I always recommend treatment because they won’t go away by themselves – they’ll most likely just continue to be painful.

Can they be zapped, crushed or dissolved?

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Unlike kidney stones, unfortunately gallstones cannot be lasered or crushed.

There is a tablet that has been shown to partially dissolve gallstones, but this is not particularly effective and if you stop taking the tablets the gallstones will come back.3

If the gallstones are in your bile ducts, they can be treated by passing a camera into your stomach and extracting them from the inside. This avoids an operation.4

But most patients have stones in their gallbladder and I believe the best way of treating these is with a keyhole operation called laparoscopic cholecystectomy.

What does the operation involve?

A laparoscopic (keyhole) cholecystectomy is an operation to remove your gallbladder, along with the stones inside it.

You do not need your gallbladder so you don’t need to worry about having it removed.3

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The operation is performed under a general anaesthetic, which means you’re completely asleep. Four small holes (about 1-2cm in length) are made in your abdominal wall and your surgeon will use these to dissect your gallbladder from your liver and remove it.

Very rarely it may not be possible to complete the operation using keyhole surgery and a bigger incision is needed. This is called open surgery.

However, keyhole surgery can offer benefits including shorter hospital stay and faster recovery compared to open surgery. For these reasons, keyhole (laparascopic) cholecystectomy is generally the preferred method.5

Removal of the gallbladder is a very common procedure with relatively few risks. It is one of the operations I perform most commonly; I perform these procedures every week and sometimes do up to five or even six gallbladder operations in one day.

How will I feel after surgery?

Keyhole surgery results in small wounds, which should not give you much pain

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While you are asleep, your abdomen is filled up with gas in order to provide space to do the operation through the small incisions. You may feel bloated from this gas after surgery and feel some discomfort in your back and shoulders. This resolves by itself after a few hours and getting up out of bed helps to get rid of this gas.

The vast majority of my patients are able to go home on the day of surgery, although quite reasonably some prefer to stay in over night to sleep off the effects of the anaesthetic.

You should feel back to normal after about two weeks.6



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Sources
1https://www.mdedge.com/ccjm/article/162140/gastroenterology/gallstones-watch-and-wait-or-intervene
2https://www.nhs.uk/conditions/gallstones/
3https://www.nhs.uk/conditions/gallstones/treatment/
4https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3348191/
5https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1941876/
6https://www.nhs.uk/conditions/gallbladder-removal/

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