Gallstones (Cholelithiasis)

Gallstones (Cholelithiasis) or Gallbladder stones are crystalline masses formed abnormally in the gallbladder or bile ducts from bile pigments, cholesterol, and calcium salts. Gallstones can cause severe pain and blockage of the bile duct. When the wall of the gallbladder is diseased then it produces the stone and polyps etc.

Most common signs and symptoms of gallstones are:

• Heartburn, frequent acidity, gas, nausea or vomiting, especially after a heavy or fatty meal.
• Sudden and rapidly escalating pain in the centre of the upper abdomen, below the breastbone. This pain may radiate to the tip of the right shoulder or back to an area between the shoulder blades.
• Repeat episodes of intense pain followed by yellow discolouration of eyes/urine/sweat/skin.
• Usually, these symptoms tend to be intermittent and episodic. The interval between two consecutive episodes may be symptom-free.

Following are the most common causes of Cholelithiasis.

• Suboptimal emptying of the gallbladder due to compromised functioning of cholecystokinin (a major stimulant for gallbladder contraction and the release of bile from it)
• Primarily, gallstones have no scientifically proven relation with food habits or lifestyle.

• Abdominal ultrasound - A reliable and commonly performed investigation that detects or rules out gallstones. The patient must be on an empty stomach before getting an ultrasound done.
• Blood tests - Includes CBC (complete blood count) and LFT (liver function test).
• MRCP (Magnetic Resonance Cholangiopancreatography) - MRCP gives the doctor a clear anatomical picture of the gallbladder, pancreas, ducts and liver. MRCP is conducted when the results of LFT are abnormal, and abnormal LFTs can be caused by stones or sludge slipping into the common bile duct.
• ERCP (Endoscopic retrograde cholangiopancreatography) - is an invasive procedure used for diagnosing and treating problems in the biliary system. It combines an x-ray and an endoscope. Any impacted stone or sludge in the common bile duct can be taken out simultaneously.

All patients with gallstones need to get their gallbladders surgically removed.

• Laparoscopic cholecystectomy - This is the most frequently performed surgery for gallstones. This procedure is carried out using highly specialised instruments based on fibre optics. Usually, the operation is performed through three or four holes measuring 1 cm or less. Sometimes a single incision approach through the navel may be performed as well.
• Open cholecystectomy - The doctor makes a larger incision in the belly, under the right lower ribs. The patient needs to remain hospitalised for a few days afterwards. This procedure is performed for select cases as most patients can be managed laparoscopically.

If left untreated, these stones may cause one or more of the following complications:

• Inflammation of the gallbladder - A gallstone that gets impacted in the neck of the gallbladder can cause gallbladder inflammation (cholecystitis), resulting in severe pain and fever. It is more common among male patients and patients with diabetes (it can be severe for people with diabetes.)
• Blockage of the common bile duct - Symptoms like severe pain, jaundice, and high-grade fever may occur due to the blockage caused by stones or sludge slipping into the bile duct.
• Blockage of the pancreatic duct - The pancreatic duct carries pancreatic juices into the intestine. It has a common opening with the bile duct. A gallstone can result in a temporary or lasting blockage in the pancreatic duct, leading to the inflammation of the pancreas (pancreatitis). This causes intense, constant abdominal pain and usually requires immediate hospitalisation and intensive care. Sometimes this can be fatal.
• Gallbladder cancer - Individuals with a long-standing history of untreated gallstones are more prone to developing gallbladder cancer.

• There is no need to avoid vegetables or fruits with seeds. Just avoid fried foods.
• Follow the food restrictions as per your medical condition like diabetes etc., if any.
• Laparoscopic surgery incisions are water resistant; hence one can bathe normally. Do not soak the incisions.
• You can climb stairs and walk as exercise if you have to. Other forms of exercise can be resumed gradually after a week of the operation. Consult your doctor regarding the range of motions you can perform.

Major benefits of minimally-invasive procedures include:

• Short hospital stay
• Early return to work and daily activities
• Relatively much less pain after the operation
• Cosmetically more acceptable

However, please consult a surgeon who best discusses the diagnostic and treatment procedures suitable for you.

Reviewed by Dr. Vidur Jyoti, Director & Head of Department - General & Minimal Access Surgery, Laparoscopic / Minimal Access Surgery, General Surgery, Department of General Surgery and Robotics on 09-Jan-2023

• Gallstone Disease and Acute Pancreatitis (Pancreatic Inflammation)
• Evolution of Keyhole Laparoscopic to Pin Hole Laparoscopic Surgery
• Getting rid of urinary stones is easy