Decoding Gallstones: When Does a Gallbladder Stone Operation Become Necessary?
By Dr. Purnendu Roy (MS, FRCS, FICS)
Founder & Chief Laparoscopic Surgeon, Genesis Hospital, Kolkata
Having practiced as a general and laparoscopic surgeon for more than three decades, a great many of my daily consultations involve queries that come down to the same thing: "Doctor, I've been found to have gallstones, but I'm not suffering from any serious pain right now. Do I really have to go under the knife?"
This fear is understandable. After all, "surgery" is a worrisome word, and as a healthcare professional, my goal is to make this change easier for you to cope with. Let me explain the function of the gallbladder, the origin of the stones, and in what instances a gallbladder stone operation becomes necessary.
What Are the Functions of the Gallbladder?
To find a solution, we must look into the problem. The gallbladder is a small, pear-shaped organ located below your liver on the right side of the abdomen. While the liver produces bile (a greenish digestive fluid), the gallbladder stores this liquid.
Upon eating fatty or oily foods, the gallbladder contracts and squeezes its concentrated contents into your intestine, enabling the digestion of dietary fats.
[Liver Produces Bile] âž” [Gallbladder Stores & Concentrates It] âž” [Squeezes into Intestine to Digest Fats]
Due to some chemical imbalance, the bile inside your gallbladder may start to crystallize, forming particles ranging in size from a speck of dust to a golf ball. There are usually too many cholesterols and/or bilirubins in this liquid, which forms the basis for these solid objects.
"Gallstones in a Silent State" – The Truth Behind the Term
Patients who have been diagnosed with silent stones usually discover the condition accidentally while undergoing abdominal ultrasound imaging in connection with another issue. These stones are often referred to as asymptomatic.
However, in case a gallstone blocks the exit canal of your gallbladder, things may quickly spiral out of control. A complete blockage of this passage results in the following conditions:
Biliary colic is the occurrence of intense pain felt in the upper right part of the abdomen. It sometimes radiates to the back or shoulder blades.
Cholecystitis refers to acute irritation or infection of the gallbladder wall, causing severe abdominal pain and symptoms such as nausea, vomiting, and fever.
Why Not Remove Only the Gallstones and Preserve the Organ?
This is the first question that comes to mind upon being diagnosed with gallstones. Why remove the whole organ if the stones are what causes problems?
As a surgeon, I completely understand your logic. However, in gastroenterology, we always deal with root causes rather than symptoms. And the fact of the matter is, the process of forming gallstones is irreversible. In other words, once the organs start producing solid objects inside it, your bile will stay chemically unstable indefinitely, or its muscle layers will remain unable to contract properly.
In case we attempted a minimally invasive operation to remove the stones, two major complications would arise:
Relapse: Since the mechanism responsible for stone formation is unaltered by simply removing the stones, you'll likely have to deal with the same painful episodes within months or even a year later.
Formation of scar tissue: By operating inside your gallbladder, we inevitably damage the walls and cause them to heal with scar tissue, which complicates any possible future operations.
Thus, to completely eliminate the condition forever, your best option is to remove the entire gallbladder since your body adapts perfectly well without this organ.
What About Stones That Escape into the Bile Duct?
In one particular case, stones can indeed be removed surgically, although it calls for an entirely different method.
When a stone gets out of your gallbladder and travels down into the common bile duct (the main passageway of bile to the intestines), it can block the whole digestive system, resulting in jaundice and pain.
To fix the problem, we need to employ a specific advanced endoscopic technique called ERCP (Endoscopic Retrograde Cholangiopancreatography). Under anesthesia, an endoscope (a thin, flexible pipe with a camera attached) is passed down the patient's mouth, esophagus, stomach, and small intestine until the bile duct opening is identified. Next, a small basket or balloon is introduced into this pipe and used to extract the stone and withdraw it.
Treatment Protocol. If a person has a lodged stone, ERCP is first done to clear the passage and preserve the functioning of the pancreas and liver. Then, depending on the doctor's recommendations, the laparoscopic operation to remove the gallbladder is scheduled.
Why Oral Medications Can't Solve the Issue Permanently
The most commonly asked questions at Genesis Hospital include whether gallstones can be dissolved using some oral medication or herbal remedy.
Although oral bile acid can occasionally resolve gallstones in some patients, the chance of success in this procedure is exceedingly small. Besides, even if it worked, it could only apply to small cholesterol stones, and this treatment requires several months or years to produce a result. What's worse, once you stop taking the pills, the stones grow back.
Also, calcium-containing and/or pigmented gallstones are impervious to medical treatments of this type. Attempts to get rid of these stones with dietary restrictions and cleanses can be extremely risky, possibly forcing a stone out of the gallbladder and into the common bile duct, thus blocking it and causing jaundice or acute pancreatitis.
Gold Standard Treatment for Gallstone Problem: Laparoscopic Cholecystectomy
However, when symptoms do manifest, it would be wise to act sooner rather than later since waiting would only exacerbate the potential complications. The most reliable course of action in such a case would be a gallbladder stone operation.
Medicine has developed considerably during the years. Nowadays, there is no need to undergo major abdominal cuts associated with open surgeries of the previous century. Instead, we conduct laparoscopic cholecystectomies.
1. Keyhole cuts: 15 minutes or less.
During the operation, the surgeon makes 3 to 4 small incisions (less than 1 cm in size each).
2. Laparoscope insertion: Diagnose.
A thin tube, which is a laparoscope fitted with a high-definition camera and capable of transmitting images in real-time, is introduced through the keyholes. You will see a highly magnified image of your inner organs on a display screen.
3. Excision of the gallbladder: Surgical skill.
Using specific devices, the surgeon separates the whole gallbladder and removes it together with the stones through one of the keyholes.
Life Without Gallbladder After Its Removal: How Does Your Body Function?
Another common question many people have concerns how one's health condition changes after removal of a problematic organ. There is no reason to worry, though; your liver continues producing the bile just as effectively as before. The main difference is that it goes directly from your liver into the small intestine without passing through the gallbladder anymore.
The majority of individuals recover from the procedure and return to their normal activities in seven days. Although you may want to avoid heavy and fatty foods in the first two weeks after the surgery, everything else should remain perfectly fine.
If you suffer from recurrent attacks of abdominal pains caused by gallstones, don't hesitate any longer. Consult with Dr. Purnendu Roy at Genesis Hospital.Â
