Gallstone Removal

What is Gallstone Removal?

Gallstone removal is a surgical procedure typically performed when gallstones cause symptoms like pain or infection. Gallstones are hard, pebble-like deposits that can form inside the gallbladder, a small organ under the liver. 

Who is Suitable for Gallstone Removal?

A person may be suitable for gallstone removal if they have the following:

• Symptomatic gallstones causing recurrent pain, which is also known as biliary colic.
• Inflammation or infection of the gallbladder (cholecystitis).
• Gallstones in the bile duct (choledocholithiasis).
• Pancreatitis (inflammation of the pancreas) caused by gallstones.

Benefits of Gallstone Removal

• Relief from Pain: The most immediate and significant benefit of gallstone removal is relief from the intense pain that gallstones can cause.
• Prevents Complications: Removing the gallbladder and its gallstones prevents complications like gallbladder inflammation (cholecystitis), gallstone pancreatitis, or a gallstone lodged in the bile duct.
• Cure: Once the gallbladder is removed, gallstones cannot recur since they primarily form in the gallbladder.
• Improved Quality of Life: Following recovery, most people can return to their normal activities and diet without worrying about triggering an attack of gallstone pain.

Types of Gallstone Removal

• Laparoscopic Cholecystectomy: This is the most common surgery for gallstone removal. The surgeon makes several small incisions in the abdomen and inserts a laparoscope (a small, thin tube with a camera) to view the inside of the abdomen and remove the gallbladder.
• Open Cholecystectomy: In this traditional surgery, a larger incision is made in the abdomen to remove the gallbladder. This method is typically used if anticipated complications arise during a laparoscopic procedure.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure is used when gallstones are lodged in the bile duct. A flexible tube with a camera on the end is passed through the mouth, oesophagus, and stomach into the first part of the small intestine, where the bile duct is accessed, and the stones are removed.

Alternative Options to Gallstone Removal

If surgery is not an option, or if a patient chooses not to have surgery, other treatments may be considered:

• Watchful Waiting: For people with gallstones that don't cause symptoms, a common approach is "watchful waiting." This means not treating the gallstones unless symptoms occur.
• Medications: Certain medications may help to dissolve gallstones, but they are often not as effective as surgery, take a long time to work, and the gallstones may return once the medication is stopped.
• Extracorporeal Shock Wave Lithotripsy (ESWL): This treatment sends shock waves through the body to break gallstones into smaller pieces. However, it's not widely used because the gallstones often return over time.

What to Do Before a Gallstone Removal?

• Medical Evaluation: Your healthcare provider will conduct a thorough medical evaluation. This may include blood tests, imaging studies, and an evaluation of your heart and lungs to ensure you're healthy enough for surgery.
• Medications: Inform your doctor about any medications, vitamins, or supplements you take. You may need to stop taking certain medicines (like blood thinners or aspirin) in the days before your surgery.
• Fasting: You'll likely be asked not to eat or drink for a certain period before the surgery, typically after midnight the night before.
• Bowel Prep: Some doctors may advise a bowel prep before surgery, but it is only sometimes necessary.
• Transportation: Plan for someone to drive you home after the procedure since you'll recover from anaesthesia.

Gallstone Removal Procedure

• Anaesthesia: Gallstone removal is performed under general anaesthesia, so you'll be unconscious and not feel any pain during the procedure.
• Depending on the type of gallstone removal procedure, the following is done:
• Laparoscopic Cholecystectomy: Several small incisions are made in your abdomen for this procedure. Carbon dioxide gas is introduced into your abdomen to create more space for the surgeon to work. A laparoscope (a long, thin tube with high-intensity light and a high-resolution camera at the front) is inserted through one of the incisions. The surgeon will then remove the gallbladder through one of the incisions.
• Open Cholecystectomy: This procedure begins with a large incision in the abdomen. The surgeon locates and removes the gallbladder through this incision.
• ERCP: In this procedure, a flexible tube with a camera at the end is passed down your throat, through your stomach, and into the beginning of your small intestine. The surgeon will then insert a small instrument to open the bile duct and extract the stone.
• After the gallbladder is removed (or the stone is removed from the bile duct), the incisions are sutured closed. In the case of laparoscopic surgery, the gas in your abdomen is allowed to escape before the incisions are closed.

What to Expect After a Gallstone Removal?

Most people go home the same day or the next day after laparoscopic cholecystectomy. An open cholecystectomy usually requires a hospital stay of a few days.

Gallstone Removal Recovery Plan

• Pain Management: Take the prescribed pain medications as directed by your doctor.
• Incision Care: Keep the incision area clean and dry. Your doctor will give you specific instructions about bathing and changing the dressing.
• Follow-Up Appointments: Make sure to attend all follow-up appointments so your doctor can monitor your recovery.
• Gradual Activity: Start with short, gentle walks and gradually increase your activity level as you recover. Avoid heavy lifting or strenuous activity until your doctor says it's okay.
• Diet: Eat a healthy diet to support your recovery. Some people find that they digest fats less well after gallbladder surgery, so you should limit fatty foods at first and then gradually reintroduce them to see how you tolerate them.
• Hydration: Drink plenty of fluids unless your doctor advises otherwise.
• Rest: Make sure to get plenty of rest. Your body needs healing energy, so don't push yourself too hard too soon.

Remember, everyone's recovery process is different. Follow your surgeon's advice and contact them if you have any concerns or experience severe pain, fever, persistent vomiting, yellowing of your skin or the whites of your eyes.

Gallstone Removal Prognosis

The prognosis after gallstone removal is typically very good. Most people who undergo gallbladder surgery do not experience any complications, and the gallstones do not come back since the organ where they form (the gallbladder) has been removed. Most people can return to normal activities and diet after a short recovery period.

Gallstone Removal Risks

As with any surgical procedure, gallstone removal carries some risks, including

• Bile leak: Bile could leak into the abdominal cavity during or after gallbladder surgery, causing pain and potentially leading to infection.
• Injury to the bile duct: There's a small risk of damage to the bile duct, which can cause bile to leak into the abdominal cavity.
• Infection: As with any surgery, there is a risk of infection at the incision site or inside the abdomen.
• Bleeding: There is a risk of bleeding during or after surgery.
• Risks associated with anaesthesia include allergic reactions, blood clots, and breathing problems.
• Postcholecystectomy Syndrome: Some people experience abdominal pain and digestive problems after gallbladder removal.

What if Gallstone Removal is Delayed?

Delaying gallstone removal can lead to complications, particularly if you're experiencing symptoms or complications from the gallstones. These can include

• Severe pain: Gallstones can cause severe, recurrent abdominal pain if not treated.
• Inflammation or gallbladder infection (cholecystitis): A gallstone blocks the gallbladder's duct and can cause inflammation or infection.
• Gallstone pancreatitis: A gallstone can block the pancreatic duct, causing pancreas inflammation.
• Gallstone ileus: This is a rare complication where a large gallstone blocks the intestine, which can require emergency surgery.
• Jaundice or infection of the bile duct (cholangitis): If a gallstone passes out of the gallbladder and blocks the bile duct, it can cause jaundice or a severe infection.

It's important to consult with your doctor if you have gallstones, particularly if you're experiencing symptoms, to discuss the risks and benefits of treatment options.