Gallstones Always Need Surgery?

Dear Dr. Dave and Dr. Dee,

I'm confused. I've had abdominal pains for a number of years. Recently my doctor diagnosed me with gallstones. She referred me to a surgeon who recommended elective surgery. I can't decide whether or not to have the surgery. I've been told that's the only way to fix the problem. What's the gall bladder for? Do they have to take out the whole thing, or can they just remove the stones?

Signed,

Confused

Dear Confused,

Having gallstones doesn't always mean that surgery is indicated. The need for urgent intervention depends largely on the location of the stones, and whether or not the gallbladder is inflamed. If the stones have moved from the gallbladder and are blocking vital organs such as the liver or pancreas, or if the gallbladder is inflamed, then urgent intervention is indicated.

But most of the time, people with gallstones aren't experiencing any of these complications. They have intermittent bouts of abdominal pain, which may be brought on by a fatty meal. The pain may last a number of hours, but then spontaneously goes away as mysteriously as it came, and stays gone for a period of days, weeks or months. These painful episodes with no other complications are called "biliary colic."

Surgery for simple biliary colic is usually elective. Whether or not to have surgery for simple biliary colic is up to the individual patient. The benefits of getting rid of the intermittent pain episodes must be carefully weighed against the risks of having surgery. The only way to make this decision is to be completely informed. Always make sure and obtain from your physician a detailed explanation and analysis of the potential risks and benefits of any medical or surgical procedure before going ahead.

WHAT IS THE GALLBLADDER?

The gallbladder is a small pouch, located beneath the liver, which stores bile. Bile is produced by the liver and is used by the body to aid in the digestion of fat. After a fatty meal such as a nice big pizza, the gallbladder contracts, ejecting its bile contents into a small duct that leads to the intestinal tract. When the bile gets into the intestine it helps dissolve fat in the food, which makes it easier for your body to absorb it.

WHAT ARE GALLSTONES?

Normally there are no solid particles in the bile, so bile flows easily through the duct down to the intestine. But some people form gallstones which may have the potential, at some time, to block flow through the duct.

Gallstones are formed from tiny crystals that form in the bile when there are imbalances in the concentration of the substances that make up the bile. Gallstones grow slowly over a period of months and years. They may be the size of grains of sand, pebbles or marbles. They tend to lay on the bottom of the gallbladder where they can go unnoticed for years.

But one day, when the gallbladder contracts after a fatty meal and ejects its bile, it may also eject a stone. If the stone obstructs the bile duct, then this causes the immediate onset of severe abdominal pain. The pain will persist until the obstruction is relieved.

SURGERY DEPENDS ON LOCATION:

With gallstones, as in real estate, it's "location, location, location." How sick you become, and whether or not you need to undergo surgery or a procedure, depends on where the stone gets stuck.

Pain from a gallstone, which obstructs only the opening at the top of the gallbladder, will tend to be transient, lasting only until the gallstone drops back into the bottom of the gallbladder. This may take minutes or hours. But when the stone drops back down to the bottom of the gallbladder the pain disappears (biliary colic episode).

Stones that pass out of the opening at the top of the gallbladder and enter into the bile duct system can be an entirely different story. The stone can get stuck anywhere in the duct between the gallbladder and intestine . If it gets stuck in a location which blocks the liver or pancreas , then it's a major problem (common bile duct stone).

Common bile duct stones blocking the liver or pancreas can make a person seriously ill, and usually require urgent intervention. Common bile duct stones may be removed surgically, or by a procedure called ERCP.

These conditions need to be ruled out. That's one of the reasons why it's always important to be seen by a doctor if you're experiencing abdominal pain. Your doctor will know which tests need to be done to rule out serious conditions.

CAN THEY JUST REMOVE THE STONES?

Generally, removal of gallstones from the gallbladder, without removing the gallbladder, hasn't yet proven effective. Removal of the gallbladder (cholecystectomy) remains the usual treatment for gallstones. The body seems to get along well enough without the gallbladder, since, after its removal, bile still flows normally from the liver to the intestine.

Cholecystectomy may be performed through an operating scope placed through tiny incisions in the abdomen, without opening the abdomen (laparoscopic holecystectomy). In some cases the old fashioned open surgery may be needed. This is done through a fairly large abdominal incision. Recovery time from laparoscopic cholecystectomy is a faster process than from open cholecystectomy.

INFLAMMATION OF GALLBLADDER:

How sick a person becomes also depends on whether or not their gallbladder is inflamed. Acute inflammation or infection of the gallbladder, called cholecystitis, is a serious condition. Acute cholecystitis is an indication for removal of the gallbladder.