Gallstones

Why do I have gallstones?

Gallstones are like pearls! Most stones are made up from a mixture of chemicals. They probably develop from a tiny crystal of calcium or a bile pigment or cholesterol. Over time, layer after layer of crystals are laid down over this to form a defined ‘stone’. We don’t know for sure why this happens but it’s more common in women than men, if you have high cholesterol and if you lose weight rapidly. There are also a number of blood cell breakdown disorders (called haemolytic anaemias) that are specifically associated with a particular type of gallstone. 

Many people have gallstones and don’t know about them. But a few people get recurrent discomfort when they eat a fatty meal or even attacks of severe pain, sometimes needing hospitalisation for antibiotics. 

We use blood tests and abdominal ultrasound (a jelly scan) to diagnose gallstones. But sometimes you may need a magnetic scan (MRCP) if there is concern that one of your stones has escaped into the bile duct.

What is the treatment of gallstones?

The best treatment is to remove the gallbladder using a keyhole operation called a Laparoscopic Cholecystectomy (see below). We can’t simply remove the gallstones, as the gallbladder has a poor blood supply and doesn’t heal up well, then you rapidly reform the stones anyhow. We can use medication to dissolve the stone but it has unpleasant side effects and you can never stop it or the stones come back. People often ask about ‘shock-wave’ therapy which is used for some kidney stones. Unfortunately, this just makes the stones smaller and then they can escape the gallbladder and lodge in the bile duct causing major problems such as pancreatitis which could threaten your life.

Don't I need my gallbladder?

The gallbladder is a storage organ. A little sac of bile coming out from the bile duct of the liver. When we eat a fatty meal this sac squeezes the stored bile out into the gut to help digest that fat. It may be a remnant from when we ate huge fatty meals (like woolly mammoth) but we don’t need this much bile anymore. Your liver still produces bile anyway and this will come down the bile duct into the gut and help digest the fat we eat without the stored bile. At the end of the day, the reason we form stones could be that your gallbladder isn’t working properly anyway. I advise to stick to a lower fat diet after surgery though as this means that your liver won’t upregulate your bile production. Too much bile in the bowel and you could get diarrhoea or biliary gastritis (inflammation of your stomach).

A laparoscopic cholecystectomy

This is a keyhole operation performed under GA, using four little cuts on your abdomen to dissect the gallbladder from it’s attachments to the liver. We need to clip and divide it’s blood supply and also it’s attachment to the bile duct: this is called the cystic duct. Then the gallbladder is placed in a sterile plastic bag and removed.

Sometimes I need to do an X-ray dye test halfway through the operation to make sure that no gallstones have escaped into your bile duct. This is called an intraoperative cholangiogram. If I find stones have escaped then I may be able to remove them there and then by exploring your bile duct laparoscopically or it may require another procedure called an ERCP on the mainland afterwards.

The whole thing takes about an hour and can usually be done as a daycase without staying overnight in the hospital.

Laparoscopic cholecystectomy is generally a very safe operation but all surgery and anaesthesia carry risks such as bleeding, infections, scarring, heart and lung issues and blood clots. If there is a problem during your operation and your life is threatened then I may have to convert to an open operation with a bigger cut. This is very unusual but would mean a longer length of hospital recovery. The risk we all talk about with removal of your gallbladder is a ‘bile duct injury’. You don’t need your gallbladder but you do need your bile duct and we come close to this during your operation. It’s possible that this gets damaged causing bile to leak out afterwards into your abdomen and can make you seriously ill. This is rare but can lead to a prolonged hospital stay and major surgery in a specialist centre to repair the duct.

Gallbladder polyps

You may be having this surgery for gallbladder polyps. Like many other polyps this is because they can turn cancerous. We get very concerned about polyps that are 10mm in size. For those between 6-9mm in the over 50s or those that are seen to be growing fast on surveillance ultrasound scans should probably also be removed. Gallbladder cancer is extremely rare but dangerous so this is usually done as a preventative action. Removing polyps requires a laparoscopic cholecystectomy.