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Before you agree to have your cholecystectomy (gall stones) operation it is important to know all you can about it. The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when making your choice of gall stones treatment with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.



What is the problem?

You have stones in your gallbladder. They often cause attacks of pain and vomiting. If stones escape from the gallbladder, they can block the bile duct, causing pain, fever and yellow staining of the skin and the whites of the eyes. This condition is called jaundice.


What is the gallbladder?

Your liver is tucked under your right ribs at the front of your abdomen. It makes a yellow-green liquid called bile. Bile helps digest food. It also gets rid of waste chemicals, such as cholesterol and a breakdown product of red blood cells called bilirubin. The bile runs down a tube, called the bile duct, into the duodenum. The bile duct opens into the duodenum at the same place as the duct from the pancreas, which makes its own digestive juice. The gallbladder is a pouch of the bile duct. It stores and concentrates the bile, ready for the next meal, when it is released.


What has gone wrong?

Some of the chemicals in the bile have crystallised out and grown into stones in the gallbladder. The stones can block the neck of the gallbladder; the gallbladder then swells up giving pain. Infections can take hold, making the gallbladder thickened and fragile. This is called cholecystitis.

Cholecystectomy 2

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 aims

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 benefits

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.

  • Less pain.

  • A lower risk of infection.

  • Smaller wounds.

  • 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

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