The gallbladder is a small sac that holds bile, a digestive juice produced by the liver that is used in the breakdown of dietary fats. The gallbladder extracts water from its store of bile until the liquid becomes highly concentrated. The presence of fatty foods triggers the gallbladder to squeeze its bile concentrate into the small intestine.

Gallstones (biliary calculi) are small stones made from cholesterol, bile pigment and calcium salts, usually in a mixture that forms in the gallbladder. They are a common disorder of the digestive system, and affect around 15 per cent of people aged 50 years and over.

Some things that may cause gallstones to form include the crystallisation of excess cholesterol in bile and the failure of the gallbladder to empty completely.

In most cases, gallstones don’t cause any problems. However, you might need prompt treatment if stones block ducts and cause complications such as infections or inflammation of the pancreas (pancreatitis).

Surgeons may remove your gallbladder (called a cholecystectomy) if gallstones (or other types of gallbladder disease) are causing problems. Techniques include laparoscopic (‘keyhole’) cholecystectomy or open surgery. The gallbladder is not a vital organ, so your body can cope quite well without it.

Symptoms of gallstones:-

In approximately 70 per cent of cases, gallstones cause no symptoms. The symptoms of gallstones may include:

  • pain in the abdomen and back. Pain is generally infrequent, but severe
  • increase in abdominal pain after eating a fatty meal
  • jaundice
  • fever and pain, if the gallbladder or bile duct becomes infected.

Causes and risk factors for gallstones:-

Gallstones are more common in women than in men. They are also more common in overweight people and people with a family history of gallstones.

There is no single cause of gallstones. In some people, the liver produces too much cholesterol. This can result in the formation of cholesterol crystals in bile that grow into stones. In other people, gallstones form because of changes in other components of bile or because the gallbladder does not empty normally.

Diagnosis of gallstones:-

Doctors diagnose gallstones by using a number of tests, including:

  • general tests – such as physical examination and x-rays
  • ultrasound – soundwaves form a picture that shows the presence of gallstones
  • endoscope test – endoscopic retrograde cholangiopancreatography (ERCP). A thin tube is passed through the oesophagus and injects dye into the bowel to improve the quality of x-ray pictures
  • hepatobiliary iminodiacetic acid (HIDA) scan – a special type of nuclear scan that assesses how well the gallbladder functions
  • magnetic resonance cholangiopancreatography (MRCP) – a form of the body-imaging technique magnetic resonance imaging (MRI). The person’s liver, biliary and pancreatic system is imaged using an MRI unit. The image is similar to an ERCP test.

Treatment for gallstones:-

Gallstones that cause no symptoms, generally don’t need any medical treatment. In certain cases (such as abdominal surgery for other conditions), doctors may remove your gallbladder if you are at high risk of complications of gallstones.

Treatment depends on the size and location of the gallstones, but may include:

  • medications – some medications can dissolve gallstones, but this treatment is only rarely given, due to side effects and a variable success rate
  • surgery.

Surgical removal of the gall bladder or gallstones:-

Around 80 per cent of people with gallstone symptoms will need surgery. Surgeons may remove your entire gallbladder (cholecystectomy), or just the stones from bile ducts.

Techniques to remove the gallbladder include:

  • laparoscopic cholecystectomy – ‘keyhole’ surgery. The surgeon makes a number of small incisions (cuts) through the skin, allowing access for a range of instruments. The surgeon removes the gallbladder through one of the incisions
  • open surgery (laparotomy) – the surgeon reaches the gallbladder through a wider abdominal incision. You might need open surgery if you have scarring from prior operations or a bleeding disorder.

Medical factors to consider before cholecystectomy:-

Before the operation, you need to discuss some things with your doctor or surgeon, including:

  • your medical history, since some pre-existing conditions may influence decisions on surgery and anaesthetic
  • any medications you take on a regular basis, including over-the-counter preparations
  • any bad reactions or side effects from any medications.

Laparoscopic cholecystectomy(Keyhole’ Surgery):-

The general procedure includes:

  • The surgeon makes a number of small incisions into your abdomen, so that slender instruments can reach into the abdominal cavity.
  • A tube blowing a gentle stream of carbon dioxide gas is inserted. This separates the abdominal wall from the underlying organs.
  • The surgeon views the gallbladder on a TV monitor by using a tiny camera attached to the laparoscope.
  • Special x-rays (cholangiograms) during the operation can check for gallstones wedged in the bile ducts.
  • The ducts and artery that service the gallbladder are clipped shut. These clips are permanent.
  • The gallbladder is cut free using either laser or electrocautery
  • The gallbladder, along with its load of gallstones, is pulled out of the body through one of the abdominal incisions.
  • The instruments and the carbon dioxide gas are removed from the abdominal cavity. The incisions are sutured (closed up) and covered with dressings.

Open gallbladder surgery:-

The general procedure is the same as for laparoscopic surgery, except that the surgeon reaches the gallbladder through a large, single incision in the abdominal wall. Sometimes, an operation that starts out as a laparoscopic cholecystectomy turns into open surgery if the surgeon encounters unexpected difficulties, such as not being able to see the gallbladder properly.

Self-care after gallbladder surgery:-

Be guided by your doctor, but general self-care suggestions include:

  • Rest as much as you can for around three to five days.
  • Avoid heavy lifting and physical exertion.
  • Expect your digestive system to take a few days to settle down. Common short-term problems include bloating, abdominal pains and changes to toilet habits.