Gallstone disease and gallbladder removal

June 19, 2013 John H. Tschirhart, MD

Gallstone disease is one of the most common reasons for patients needing surgery and the source of a great deal of misery.  Fortunately, for the vast majority of patients, gallstone disease can be dealt with safely and fairly easily.

What is Gallstone Disease?

One of the many things your liver does is produce bile. This bile is secreted into your intestine through the bile ducts. In the intestine, it acts to dissolve the fat that we eat that the fat can be absorbed by the intestine.

In between meals, a small muscular valve closes where the bile duct enters the intestine.  The bile that is produced then gets backed up into the gallbladder, which acts as a reservoir, both holding and concentrating the bile.  After a person eats, the presence of food in the stomach and duodenum sets off a signal to the gallbladder which then contracts, adding bile to mix in with the food.

Approximately 20% of people (1 out of 5) form gallstones in their gallbladder. Most stones are made of cholesterol, and cholesterol is a normal part of bile. In most cases, other chemicals present in bile keep this dissolved, but if these chemicals are not in the proper proportions, the cholesterol separates from the bile and forms stones.

Most people with gallstones never have a problem with them, and their mere presence isn’t an indication for surgery. However, several problems can arise.  Stones can get stuck in various places, including the duct that joins the gallbladder to the common bile duct, in the bile duct itself, or stones can also block the pancreatic duct which drains other digestive enzymes into the intestine.  The consequences of these situations range from intermittent severe attacks of pain in the upper and right abdomen and right shoulder, to potentially life threatening or crippling conditions such as cholangitis (infection in the bile duct) and pancreatitis.

How do you treat gallstones?

The treatment for symptomatic gallstones is removal of the gallbladder and its contained stones.  I’m often asked why we can’t just take the stones out, dissolve or break them up, etc.  These have all been explored, and none of these strategies seem to work effectively, because the patient’s liver and gallbladder make bile that is prone to stone formation.  Any therapy that leaves the gallbladder in place is likely to lead to recurrence of the stones.  The vast majority of people who have had their gallbladders removed have no problems with diet, bowel function, etc. after the surgery.

Prior to about 20 years ago, the typical surgical treatment involved removal of the gallbladder through a large incision under the ribcage on the right.  Fortunately, since that time the development of laparoscopic surgery has allowed us to perform the same removal through 4 small incisions.  This results in much less pain after the operation, and a much faster return to normal activity.  Nowadays, this is normally performed as outpatient, same day surgery, and most people are back to work in about a week.

The newest surgical treatment available is with robotics and the Single-Site® Cholecystectomy (gallbladder removal). For some patients, surgeons are able to remove the gallbladder through one small incision made in the naval using the da Vinci® surgical system. Procedure time, risk of infection, length of stay, and reduced pain and blood loss are comparable to the laparoscopic approach.

There are of course risks to any surgery and I tell people that there is no such thing as minor surgery.  If you do find yourself in need of gallbladder surgery, your surgeon should go through a full explanation of the risks, benefits, and treatment options, as one would expect for any procedure.

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