Gallstone disease is a common problem that affects the body’s biliary system, which includes the liver, gallbladder, and bile ducts that release bile (a thick, yellowish fluid) into the small intestine to aid digestion. Sometimes the bile hardens, forming small, solid particles referred to as gallstones.
Usually, symptoms occur only when there are complications, in which case, you may require surgery to remove your gallbladder. But like other disease processes, you benefit by understanding more about the disease itself and how surgery as treatment resolves the symptoms.
Why Surgery Is Done
If you have gallstones, removing the gallbladder prevents further attacks. The gallbladder is a small organ located under the liver, which stores the bile the liver produces. Your body uses bile to break down fat, so whenever you eat foods that contain fat or cholesterol, the gallbladder releases bile into the intestine.
However, hard, crystal-like particles can form in the gallbladder when levels of certain substances in bile are high. These solid particles form either as the result of bile that has too much cholesterol in it or high bilirubin (bile pigment) in the gallbladder.
Yellow-green cholesterol stones, which are made up of hardened cholesterol, are the most common type of gallstone. Some of these stones are as small as grains of sand; others can be as large as a golf ball. You can have one large gallstone or many tiny stones.
Pigment stones, which are less common, form from an increased amount of bilirubin. They are smaller and darker in color than cholesterol stones. Black pigment stones, which are usually found in the gallbladder, often are caused by hemolytic anemia — a condition that destroys red blood cells. Individuals who have recently had roundworm or E. coli infection are at greater risk of developing softer, brown pigment gallstones that normally occur in the bile ducts.
A gallstone that gets lodged in a bile duct blocks the flow of bile. When this happens, you may develop symptoms such as nausea, vomiting, and pain in the upper right abdomen that can radiate to the back or right shoulder. Additional symptoms include bloating, loss of appetite, weight loss, and loose, oily stools. In severe cases, you can develop fever and jaundice — a condition characterized by your skin and the whites of your eyes turning yellow.
If medication fails to break down gallstones, surgery may be necessary to prevent recurrent episodes of cholecystitis, or inflammation of the gallbladder. Medication can take months to dissolve gallstones, and attacks often recur once your stop taking the medication.
Although eating fewer fatty foods and maintaining a healthy body weight are lifestyle practices that are good for your overall health, they aren’t always enough to reduce the risk of acute or chronic inflammation of the gallbladder. The pain of an attack, which can last for minutes or for several hours, occurs when a gallstone moves from the gallbladder into a bile duct.
How Surgery Is Performed
Surgeons often use a technique known as laparoscopy to remove the gallbladder. A minimally invasive surgery, laparoscopic cholecystectomy involves making several small incisions to the abdomen. However, the surgeon may need to perform an open surgery if you have scar tissue near the gallbladder from a prior abdominal surgery or if you have severe gallbladder disease that leads to an enlarged liver and spleen.
If your surgeon recommends a laparoscopic procedure, he or she will insert a thin tube with a small, lighted camera at the end, along with tiny surgical tools, through one of the incisions in your abdomen. Your abdomen is then inflated with gas to allow the surgeon more room to work as he or she removes your gallbladder through the incisions.
After removing your gallbladder, the surgeon will take x-ray images of the bile ducts to check for other duct obstructions before stitching up the incisions. Generally, laparoscopic gallbladder surgery is an outpatient procedure that takes about 90 minutes.
What Complications Can Occur Without Surgical Treatment
Besides the pain that inflammation of the gallbladder causes, other potential complications include serious infection and formation of scar tissue. If you experience symptoms but gallbladder disease goes untreated, gallstones can block the ducts in the pancreas, leading to pancreatitis, which also causes nausea or vomiting and abdominal pain that can radiate to the back.
Other symptoms include fever, chills, a tender abdomen, weakness, and pain that worsens after you eat. Although the symptoms of pancreatitis can range from mild to severe, the condition can lead to serious, or even life-threatening, complications. These may include malnutrition, diabetes, a pancreatic pseudocyst, an infection in the pancreas, or pancreatic cancer.
Severe pain, internal bleeding, and infection can occur if a pseudocyst ruptures. Severe infection, particularly abdominal infection or bloodstream infection, can cause sepsis — a condition that without treatment can lead to multi-organ failure and death.
When looking for relief from pain caused by gallstones or the complications of gallstones, contact The Surgical Clinic to schedule an appointment to discuss whether you need surgery.