What are gallstones
Gallstones are common and form in the gallbladder for various reasons. Common risk factors for gallstones include being female (due to hormonal reasons and pregnancies), older age and diets high in fatty food and cholesterol.
What types of gallstones are there?
The most common type of gallstone is formed of cholesterol and can be of various shapes and sizes. Some patients can have ‘grit’ or ‘debris’ within the gallbladder which can cause similar problems to stones.
What symptoms are caused by gallstones?
Gallstones can cause a variety of symptoms, but most commonly this is abdominal pain on the right side or upper parts of the abdomen after eating a meal (this is called biliary colic).
Fatty and greasy meals usually cause these problems. This usually goes away within 30 minutes to one hour and might need painkillers.
What is cholecystitis?
Cholecystitis is when infection within the gallbladder develops due to a gallstone causing a blockage; this causes more severe constant pain and features of infection such as a high temperature or feeling unwell.
Patients with cholecystitis usually come to hospital for treatment. Luckily more severe complications from gallstones such as pancreatitis (swelling and infection of the pancreas gland) or jaundice (yellowness due to a blockage of the bile duct) are uncommon.
What is the treatment for gallstones?
The treatment for gallstones which cause symptoms is usually a laparoscopic cholecystectomy (keyhole removal of the gallbladder). Gallstone removal surgery is normally performed as a daycase or a short overnight stay.
What does a Laparoscopic Cholecystectomy involve?
Laparoscopic cholecystectomy involves using a tiny camera and surgical instruments that are inserted through small cuts (incisions) in your abdomen. Removal of the gallbladder (cholecystectomy) is a relatively quick and safe procedure, but, like all operations, there is a small risk of complications. In around 2-3% of cases conversion to open surgery is required.
This pre-operative educational youtube video explains the operation
What are the major risks of laparoscopic cholecystectomy?
Cholecystectomy is usually a fairly simple and low risk procedure. However, the following risks can occur:
An infection can occur after any type of abdominal operation and occurs in around 1 in 15 cholecystectomies. Both simple wound infections and infections inside your abdomen can be treated with a short course of antibiotics. This most commonly affects the wound near your belly button, as this is the largest wound for the camera and where the gallbladder is removed from.
Bleeding (haemorrhage) can occur after your operation, although this is rare.
When the gallbladder is removed, special clips are used to seal the tube that connects the gallbladder to the main bile duct, draining the liver. However, bile fluid can occasionally leak out. Sometimes this fluid can be drained off by a radiologist inserting a drain guided by ultrasound. Occasionally an operation is required to drain the bile and wash out the inside of the abdominal cavity. Bile leakage occurs in around < 1% of cases.
Injury to the bile duct
The most serious complication of gallbladder surgery is injury to the bile duct, which occurs in about 3 in 1000 cases. If the bile duct is injured during surgery, it may be possible to repair it straight away. In some cases, complex and major corrective surgery is needed after your original operation. The best way to avoid this complication is to avoid it. Mr Griffiths takes particular care to avoid this complication and uses the ‘critical view of safety’ technique for the surgery. He also has a very low threshold for performing a dye test called an ‘intra-operative cholangiogram’ to give a road map of the biliary system.
Injury to intestine, bowel and blood vessels
The keyhole instruments used to remove the gallbladder can injure surrounding structures, such as the intestine, bowel and blood vessels. The risk is increased if the gallbladder is inflamed. This type of injury is rare and can usually be repaired at the time of the operation. Sometimes injuries are noticed afterwards and a further operation is needed. Luckily these complications are rare.
Some patients notice loose stools or diarrhoea after their operation to remove the gallbladder. This occurs due to the bile following directly in to the intestines rather than getting stored in the gallbladder. Usually this resolves of its own accord as the body gets use to the situation.
Gallstones are small stones, usually made of cholesterol, that form in the gallbladder. In most cases they do not cause any symptoms and do not need to be treated. However, if a gallstone becomes trapped in a duct (opening) inside the gallbladder it can trigger a sudden intense abdominal pain that usually lasts between one and five hours.
This type of abdominal pain is known as biliary colic. The medical term for symptoms and complications related to gallstones is gallstone disease or cholelithiasis. Gallstone disease can also cause inflammation of the gallbladder (cholecystitis). This can cause persistent pain and a high temperature (fever) with abdominal tenderness. In some cases a gallstone can move into the pancreas, causing it to become irritated and inflamed. This is known as acute pancreatitis and causes severe abdominal pain that gets progressively worse. It is often associated with vomiting and feeling unwell.