How can gallstones be treated?
A lot of people have gallstones without noticing them. If they do get symptoms, many people wonder what they should do: wait and just treat the symptoms at first, or have surgery? Read about the advantages and disadvantages of the different treatment options.
If the gallstones don't cause any problems, then there is usually no need to treat them. A lot of people with gallstones don't have any symptoms for a long time. What's more, any treatment can have side effects, and surgery always carries certain risks. Gallstones are treated differently than stones in the bile ducts.
Symptoms such as cramp-like pain can be relieved with medicine. But surgical removal of the gallbladder is the only way to prevent symptoms that are causing problems in the long term. That may also be an option for people who don't have any problems, but who have very large gallstones or certain types of porcelain gallbladder (with a calcified gallbladder wall). That puts them at greater risk of developing gallbladder cancer.
Which medications can help?
Several painkillers and antispasmodic medications are available for the relief of painful colic. Symptoms like bloating or nausea can also be treated with medicine.
But medicine is not commonly used to remove gallstones. That can be done if the gallstones are small cholesterol stones inside the gallbladder. Tablets containing the active ingredient ursodeoxycholic acid (UDCA) are used to dissolve gallstones. They need to be taken for a longer period of time (sometimes more than two years) and often don't work. New gallstones often form as well. So this treatment is only considered in a small number of people who have mild symptoms and/or infrequent colic.
What are the advantages and disadvantages of surgery?
Removing the gallbladder is the only way to permanently prevent painful colic caused by gallstones. Several factors need to be considered when deciding if and when this step should be taken:
- What are the chances that the symptoms will reappear? Some people have symptoms very often, whereas others only have them rarely or just once.
- How much do they generally trouble you? Do the gallstones cause severe upper abdominal pain and colic, or milder symptoms?
- How certain is it that gallstones are causing the symptoms? If you have upper abdominal pain and colic, gallstones are very likely to be causing it. Problems like digestion issues often have other causes.
- How high is the risk of complications such as inflammation of the gallbladder?
- What are the advantages and disadvantages of surgery? Some people have a higher risk of complications from surgery than others, for example because they are older or have other medical conditions.
In Germany, people who decide to have surgery can look for a hospital in the "White List" (a reference guide called the "Weisse Liste" in German) to find out how often they perform similar operations.
Laparoscopy or open surgery?
Nowadays, gallbladders are usually removed in a minimally-invasive surgical procedure called laparoscopy. This procedure involves making three or four cuts (incisions) in the abdominal wall under general anesthetic. The surgeon inserts thin tubes through these incisions so that very small instruments can be moved along them to reach the gallbladder. Other laparoscopic approaches have been developed for this purpose in recent years. These involve inserting the tubes and instruments into the abdominal cavity through the vagina, stomach or navel (belly button).
If there is no medical reason not to, the procedure can be performed in an outpatient setting, so you can return home the same day. It is just as possible to recover from surgery at home as it is in the hospital, and the risk of complications is about the same.
Open surgery requiring a hospital stay is only rarely necessary when removing the gallbladder. But some people may have open surgery if, for instance, they have complications or adhesions in their abdomen. It takes longer to recover from open surgery than from laparoscopy. But there is no evidence that laparoscopy is associated with fewer complications.
What risks are associated with surgery?
In Germany, hospitals are required to record data about how often complications arise following certain procedures. About 1,200 hospitals provide these data for gallbladder removal. The data are analyzed once a year. In the following table you will find data for laparoscopies in the year 2014:
|Type of complication (requiring treatment)||Complications per 1,000 procedures (laparoscopy)|
|Injury to the bile ducts||4|
Source: AQUA Institute 2015 (data from 2014)
If the bile ducts are injured, it could lead to problems like acute inflammation in the abdomen. Any scar tissue that forms may cause the bile duct to become narrower, which might make it necessary to have ongoing treatment.
How are bile duct stones removed?
Gallstones only rarely develop in the common bile duct itself. Most bile duct stones develop in the gallbladder and move into the bile duct from there. But bile duct stones are more likely than gallbladder stones to lead to inflammation of the gallbladder and pancreas. Waiting is still an option if you have bile duct stones, though: They often move out of the duct on their own and don't cause any problems.
Bile duct stones can be removed using laparoscopy or open surgery – or during an endoscopic examination known as endoscopic retrograde cholangiography (ERC). If there are other gallstones in the gallbladder, it can be surgically removed at a later time in order to prevent complications. In about 5 to 10 out of 100 people, ERC leads to complications like pancreatitis and damage to the bile duct, stomach or bowel.
How are inflammations treated?
Gallbladder inflammations are usually caused by gallstones. The treatment is given at a hospital, involving antibiotics and painkillers at first. Eating or drinking is restricted or forbidden until the acute inflammation has gone away, usually after one to two days. Patients are put on a drip to ensure that their body gets enough fluids.
Once this acute treatment is finished, the surgical removal of the gallbladder is typically recommended in order to keep the inflammation from returning and avoid complications. People who have had a mild inflammation may not need surgery. But there isn't enough research on the long-term consequences of not having surgery. For example, it is not known how not having surgery affects the risk of severe complications.
Once a decision has been made to have surgery, there are advantages to having the procedure done within a few days of diagnosis. In the past, doctors tended to first wait a few weeks until the inflammation had cleared up completely. But if surgery is held off for a few weeks, it is more likely that emergency surgery and longer hospital stays will be needed. Waiting doesn't carry any other risks, though.
If the bile ducts are inflamed, there is a risk of pancreatitis. So the gallstones are removed as quickly as possible using ERC.
How do people manage without a gallbladder?
Many people who are going to have surgery wonder what it is like to live without a gallbladder. Not having a gallbladder is generally not associated with any major disadvantages. Without a gallbladder, all of the bile produced in the liver flows directly into the small intestine through the common bile duct, without being stored first. Some people have to empty their bowels more frequently as a result, and their stool may be looser. But this is often only temporary.
Although colic usually stops after surgery, there is no guarantee that the symptoms will go away completely. For instance, bloating and flatulence might still be a problem. And other gallstones could develop in the bile ducts, causing problems.
People do not necessarily have to change their diet after surgery. Many can carry on eating what they ate before, without any problems.
If certain foods lead to digestive problems after surgery, it may be a good idea to make a few changes to your diet. Your doctor can help you. People are often advised to cut down on fats and eat more fiber. Trial and error is the best way to find out which foods agree with you, and which do not.
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