Gallstones disease is a condition that develops after the formation of gallstones (deposits of bile) in the gallbladder or in the biliary tract. Most people with gallstones are asymptomatic, and it’s only when there are complications, that gallstones make themselves known.
In this article, renowned consultant general and upper GI surgeon, Professor Khurshid Akhtar provides a comprehensive view of gallstones disease and gallbladder removal. He talks what are the symptoms of gallstones, what are the different treatment options, and if patients have any problems after surgery for having no gallbladder.
How many people in the UK are affected by gallstones?
Gallstones are among the most common causes of abdominal pain in young women. It is estimated that 3.5 million people in the UK have gallstones, and women are twice more likely than men to be affected. In England alone, more than 40,000 patients require a gallbladder removal operation each year due to ailments caused by gallstones. However, not all patients with gallstones will be symptomatic, and 20% may never develop any symptoms and not require treatment at all.
What are the different types of gallstones?
There are three different types of gallstones: cholesterol stones, pigment stones, and mixed stones.
As of today, no direct association has been found between the type of gallstones and the symptoms it will cause. Usually large and fewer in number, cholesterol stones will most likely remain asymptomatic. On the other hand, there is a strong possibility for multiple small stones to result in symptoms and complications, such as jaundice and pancreatitis.
The cause of gallstones is still unknown, but strong evidence points towards the imbalance in the bile’s content as a trigger for the precipitation of components, and eventual gallstone formation. We still don’t fully understand the reason behind this occurrence, and why it occurs in some patients and not in others.
What are the symptoms of gallstones?
Abdominal pain is the most common symptom, and this appears suddenly and is severe and colicky in nature. Some patients often compare it to being worse than labour pain. Commencing in the epigastrium (the upper central part of the abdomen) or in the right side of the upper abdomen, the pain radiates to the back and in the region of the right scapula.
Usually lasting for 2 to 4 hours, this pain is more likely to appear after the consumption of a large meal. Called a biliary colic, the patient feels in good health again once the pain is resolved. Recurrent onslaughts of pain are more likely to occur after a patient has already experienced the first one.
Acute cholecystitis is the second most common symptom. According to data from the UK Hospital Episode Statistics for 2003 to 2005, more than 25,740 patients were admitted with acute gallbladder disease as emergencies. Due to the blockage of cystic duct from the gallstones, there is also inflammation of the gallbladder, and abdominal pain, fever and nausea vomiting, which cause patients to feel ill. In most cases, patients require hospital care, with doses of intravenous antibiotics and painkillers. The patient requires a gallbladder removal operation once acute cholecystitis (inflammation of the gallbladder caused by a gallstone obstruction of the cystic duct) has occurred, either urgently - during the same admission day - or at a later date with a planned operation. There is a risk of a further acute attack while a patient waits for an operation, and avoiding fatty meals and smoking could reduce the chances.
Jaundice and pancreatitis are less common symptoms of gallstones disease. Due to the blockage of the bile duct by the gallstones that pass in the bile duct, from the gallbladder through the cystic duct, jaundice is produced. Potentially a serious condition, pancreatitis can cause patients to become very ill, often becoming life threatening.
How are gallstones diagnosed?
An examination of the gallbladder and bile duct, using an ultrasound machine, is the best way to confirm or discard a gallstones diagnosis. This ultrasound examination is acutely precise at confirming or discarding a gallstone disease diagnosis. Further investigations, like MRI or CT scans, are sometimes carried out to help clarify diagnosis in difficult cases, especially in patients with obesity.
What is the treatment for gallstones?
The removal of the gallbladder along with gallstones, by surgical operation, is the best treatment for symptomatic gallstones, which results in no side effects for the majority of patients. Abdominal bloating and diarrhoea may be experienced in up to five per cent of patients. Rarely anyone requires anti diarrhoea medication and bile salts, and the side effects usually settle in a few months.
What is a laparoscopic cholecystectomy?
A laparoscopic cholecystectomy is the operation for the removal of the gallbladder, done by keyhole technique. Only patients who are fit for anaesthesia can have this surgery, because a general anaesthesia is required for this operation. Four incisions of up to 1cm in size are performed through this operation, which is done either as a day case or with only an overnight stay in the hospital. Within two weeks of the operation, the majority of patients can get back to their day-to-day activities, including driving, as recovery from the operation is quick. An open cholecystectomy, which involves prolonged recovery time of up to six to eight weeks, and a longer stay in the hospital, may be required for two per cent of patients. It is important to know that gallbladder surgery carries potential risks like any other operation and injury to the bile duct is a serious complication, although its incidence is very low.
What type of patient is a cholecystectomy for?
This operation can be done in patients with symptomatic gallstones, where the patient is fit for general anaesthesia, given that this operation requires the patient to be put to sleep. A cholecystectomy is done by keyhole in 98% of cases.
What can patients expect after a cholecystectomy?
Within the same day, or within 24 hours, of the operation, the majority of patients can go home. To reduce any discomfort, you will be prescribed painkillers, although pain is minimum after undergoing any type of keyhole operations. Within the first week, patients are usually advised not to drive, but you should be able to drive in the second week of the operation if pain and discomfort are not a problem. Within three to four weeks after the operation, you should be able to return to work. Rest may be required if your work requires heavy duty.
Are there any problems after the operation if patients have no gallbladder?
It is most likely that a patient’s gallbladder is not working if there are stones present. As previous symptoms disappear, most patients feel better after the removal of the gallbladder. Usually, there are no issues with eating and no other symptoms due to not having a gallbladder - you won’t miss your gallbladder, in short! Abdominal bloating and diarrhoea might be experienced in five per cent of patients after the operation, but within two to three months, these symptoms usually settle in the majority of cases. Symptoms may persist and a patient may require medication to control this, in a small number of cases.
Professor Khurshid Akhtar is an extensively trained consultant general and upper gastrointestinal surgeon based in Manchester and Wilmslow who specialises in the surgical management of gallstones, hiatus hernia, heartburn, and Barrett’s oesophagus. If you would like to book a consultation, or simply wish to know more about the surgical treatment of gallstones, don’t hesitate to visit Professor Akhtar's Top Doctors profile today.