If the stone drops back into the gallbladder the pain and swelling usually settle down but it often happens again. This can make the gallbladder very thick and stuck to other tissues. If it does not settle down the gallbladder can burst. This is very serious.
Sometimes stones pass into the bile duct and block it. This causes pain, fever and jaundice, in this case called obstructive jaundice.
If a stone runs down and blocks the opening of the pancreatic duct, this can cause pancreatitis. Both these conditions can be very serious and even life threatening.
The aim is to remove the gallbladder and all the stones. We do this either with laparoscopic surgery, also called keyhole surgery, or with an open operation. The gallbladder is freed off using a special electric current, called electrocautery. Some surgeons use a laser during a laparoscopic operation to free off the gallbladder. You will have a general anaesthetic and be unconscious during either operation.
The operation will remove the dangers of the present stones. It will also remove the gallbladder so that new stones cannot form. You do not need a gallbladder. The small bile ducts in the liver just become a little larger to act as a store for the bile. Recently, laparoscopic surgery has become more common and laparoscopic cholecystectomy is now routine. But laparoscopic surgery is not possible in all cases. You should discuss the type of operation to be done with your surgeon. Laparoscopic cholecystectomy has a number of advantages over the open operation, namely:
A quicker recovery.
A shorter hospital stay.
A lower risk of infection.
Less formation of adhesions.
The surgeon can examine the rest of the abdomen.
The main disadvantage is that injury to other organs, such as bowel, bile ducts or blood vessels is more likely.
What if you do nothing?
If your gallstones have been causing problems, doing nothing means that you are likely to have more of the same trouble. This may only be more pain from the gallbladder, which is unpleasant, but rarely dangerous on its own.
If you have had only one attack of cholecystitis, you may like to wait and see. If you feel you could not take the operation, and especially if you are over 70 years old, this is worth thinking about.
If your gallstones have been found during routine scanning and they are not causing any problems, there is much less need to have the gallbladder removed. You may like to wait and see.
If you have had jaundice, or pancreatitis, you can get seriously ill in another attack. Having the gallbladder taken out is sensible.
If you have gallstones, but your symptoms are unusual, there is about a one in 10 chance of the symptoms continuing after removal of the gallbladder. An operation may be the only way of finding out whether the stones are the cause of your symptoms.
Are there any alternatives?
Dissolving the stones away by drug treatment has given disappointing results. It takes many months of treatment. Often the drug cannot get into the gallbladder. The stones may not dissolve away if they are too big or chalky. The stones usually come back after the treatment has stopped.
Shock wave treatment to break up the stones is still experimental. At the present time, it just makes drug treatment a little better. The problem is that there is no flow of bile to flush the stones away.
Some surgeons favour a very small open operation called a mini-operation. It has many of the disadvantages of keyhole and open operations, but few of the advantages.
Author: Mr Michael Edwards FRCSEng FRCSEd. Consultant general surgeon.
© Dumas Ltd 2006