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.

There are mainly two types of gallstones:

1. Cholesterol Stones- Usually yellow-green in color, approximately 80% of gallstones are cholesterol stones. Stones made of cholesterol which are the most common. Many people have a misconception about these stones that they have some relation with cholesterol levels but this is not true at all.
   
2. ​​​​​​​Pigment Stones- These stones are smaller and darker and are made up of bilirubin. This can occur when red blood cells are being destroyed (hemolysis). This condition leads to excessive bilirubin in the bile.

Most common signs and symptoms of gallstones are:

• Constant or frequent pain in the right upper or middle upper abdomen
• Fever
• Yellowing of skin and whites of the eyes (Jaundice)
• Clay-colored stools
• Nausea and vomiting
• Abdominal bloating (gas problem formation)
• Recurring intolerance to fatty foods
• Belching
• Indigestion

Gallstone attacks often follow fatty meals, and they may occur during the night. Though many patients with gallstones have no symptoms and they are to be asymptomatic, the stones are called ‘Silent stones’. However, a typical attack can cause the following:

• Severe pain in the right upper abdomen that increases rapidly and lasts from few minutes to several hours
• Pain in the back between the shoulder blades
• Pain under the right shoulder
• Nausea or vomiting

The easiest ways to detect gallstone symptoms is X-ray, Ultrasound, abdominal CT scan etc.

Following are the most common causes of Cholelithiasis.

• People who are overweight are more likely to form gallstones.
• Excess estrogen from numerous pregnancies, hormone replacement therapy, or birth control pills may increase cholesterol levels in bile, slow down gallbladder emptying, and lead to gallstones.
• People who have biliary infections can develop gallstones.
• Individuals with hereditary blood disorders such as sickle cell anaemia are more likely to form pigment stones.
• Excessive dieting and consuming certain cholesterol-reducing drugs can also increase the risk of gallstone formation.
• Obesity
• Diabetes
• Rapid weight loss
• Prolonged fasting
• Hereditary blood disorders
• Unknown geological factors such as gallstones are much more common in the northern and eastern part of India.

1. Women are more prone than men
2. People in their 30's and 40's
3. Overweight men and women
4. People with rapid/ sudden weight loss
5. Pregnant women, women on hormone therapy and those who use birth control pills for a prolonged period

1. Blood tests
2. Complete blood count
3. Liver function test
4. Coagulation profile
5. Abdominal ultrasound
6. Cholescintigraphy (HIDA scan)
7. Endoscopic retrograde cholangiopancreatography (ERCP)
8. Magnetic resonance cholangiopancreatography (MRCP)

Gallstones are not found until one goes for an ultrasound. Gallbladder surgery is primarily not chosen as an option unless symptoms begin to appear.

Surgical Treatment

• Spider system is used for the first time in Asia Pacific by Dr. Pradeep Chowbey. This is one of its kind virtually scarless surgical techniques which give excellent cosmetic results.
• Laparoscopic Cholecystectomy (removal of gall bladder along with stones) – This is the most commonly used treatment option and involves making small surgical incisions thus ensuring faster recovery. Patients are often discharged from the hospital on the same day as surgery, or the next morning.
• Open/ Conventional Chole - Before laparoscopic surgery came in, gallbladder surgery required a long transverse incision in the upper right abdomen. The patient was required to stay in the hospital for 4 to 5 days. Post-operative pain was significant and return to work was almost for 3 to 4 weeks.
• Single Incision Laparoscopic Surgery - A single incision of 2 cm is given in navel and through which three ports of 5mm size are placed. The surgery is technically challenging and reserved for “simple gallbladder”.
• Mini Laparoscopic Chole - The procedure requires one 10 mm port and three 2/3 mm incisions in the upper abdomen. As compared to Laparoscopic Chole, the mini laparoscopy has distinctive advantages like decreased post-operative pain, scarless, stitch-less surgery, and shorter hospital stay. The procedure can be performed as a daycare procedure.

Non-Surgical Treatment

Non-surgical approaches for gallbladder stones treatment are used only in special situations such as when a patient's condition is not fit for anaesthesia and surgery. This does not cure the patients as it only provides symptomatic relief.

Symptomatic Management

• Treatment of symptoms of pain with injectable or oral painkillers.
• No medical therapy is available for gallstones as such which can cure the disease. Injectable or oral antibiotics and supportive medications are available for treating the infection and overcoming the acute attack.

With state of art technology and experienced doctors, Max Hospitals is amongst the best gallbladder stones surgery hospital in India.

• Recurrent severe abdominal pain or vomiting.
• Jaundice due to blockage of the common bile duct due to stones.
• Acute pancreatitis (swelling of pancreas) which can have catastrophic sequel of multi-organ failure and other serious complications. It may be fatal if severe.
• Pus formation in the gallbladder (Empyema).
• Gangrene and perforation of the gallbladder.
• Cholangitis (life threatening infection of biliary system).
• Associated with Cancer of gallbladder in the long term.
• Cholecystitis happens when the flow of bile is stopped or interrupted due to stone (90%) or if infection of biliary tract occurs.

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