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:

• Heartburn, frequent acidity, gas, nausea or vomiting, especially after a heavy or fatty meal.
• 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.

• Suboptimal emptying of the gallbladder due to compromised functioning of a hormone called cholecystokinin, the major stimulant for gallbladder contraction and the release of bile from it.
• 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

• 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 at the same time.

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. Vidur Jyoti. 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.

• 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 transient 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 any 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, and 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

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