Gallstones: how they are formed?

Gallstones are solid materials, made up of crystallised cholesterol and bile salts. Gallstones can range from the size of a grain of sand to the size of a golf ball.

It is not clear why some people get gallstones, but there are factors that increase your risk, including:

  • Being female
  • Aged over 40
  • Obesity
  • Rapid weight loss – e.g. after weight loss surgery or a crash diet
  • Oestrogen, as found in HRT and birth control pills
  • Diabetes
  • Cholesterol lowering drugs

The Gallbladder

The gallbladder is a small sac, about the size and shape of a pear, which lies under the liver on the right side of the upper abdomen. It is connected to the liver and the bowel through tubes known as the cystic and the common bile ducts. The role of the gallbladder is to store and concentrate bile produced by the liver and release it to aid food digestion.

What are the symptoms of gallstones?

The most common symptom of gallstones is pain, usually in the right upper abdomen. However, it can sometimes feel like a tight band running across the whole area and the pain may also radiate to the back, between the shoulder blades. This is sometimes referred to as “biliary colic” and may be associated with nausea and vomiting. The pain can last from 15 minutes to several hours and attacks of pain may be separated by weeks, months, or even years, with no defined pattern.

Some patients with gallstones experience no symptoms and the stones are only discovered by chance. No treatment is required for silent (asymptomatic) gallstones.

Complications of Gallstones

Gallstone pain occurs when a stone blocks the cystic duct. If this is prolonged then it may cause inflammation and infection of the gallbladder – a condition known as acute cholecystitis. This is usually an emergency and requires hospital admission for pain control and antibiotics, as well as urgent surgery to remove the gallbladder.

Gallstones can also move and lodge in the main bile duct causing an obstruction. This will lead to jaundice, dark urine and skin itching. Some people will also develop a fever and shaking which requires urgent medical attention.

Inflammation of the pancreas (acute pancreatitis) is a potentially life-threatening complication of gallstones. This can occur when a gallstone blocks the common channel of the main bile duct and the pancreatic duct, where they both drain into the bowel (duodenum). This requires urgent hospital admission and management.

How are gallstones diagnosed?

Gallstones are diagnosed by:

  • An assessment of a patient’s clinical history and symptoms
  • An ultrasound scan of the abdomen (most common)
  • A CT scan may also be used, but this is less accurate than ultrasound in diagnosing gallstones
  • MRCP, or Magnetic resonance cholangiopancreatography, which uses a large magnet and radio waves to give clear images of the bile ducts, gallbladder, and pancreas. It can diagnose stones in the gallbladder, as well as those that may have moved into the bile ducts
  • Endoscopic ultrasound, which is a highly specialised test combining endoscope and ultrasound techniques. This can get very close to the gallbladder and bile ducts to produce more accurate results than traditional ultrasound.

How are gallstones treated?

There is generally no need to treat gallstones that are not causing any symptoms. However, patients experiencing pain will probably see their symptoms recur at some point in the future which, in a small minority of cases, can lead to life-threatening complications. Under these circumstances, it is advisable to consider treatment.

The best option is to remove the gallbladder with the stones. This is known as a cholecystectomy and is routinely performed using laparoscopic or keyhole surgery. The operation is performed under general anaesthetic (asleep) and takes about half an hour to complete.

Preparing for a gallbladder operation:

Once you have decided to have your gallbladder removed, we may recommend blood tests to check your liver and kidney function, a blood clotting test and possibly an ECG to check your heart trace (dependent on your age and medical history). You may also need to temporarily stop taking some medications, such as blood thinning drugs. However, the Apple Surgical Clinic team will be able to advise you.

After discussing the pros and cons of your operation we will need you to sign a written consent form to confirm that you are happy to go ahead with the procedure.

You will also receive instructions about reporting to the hospital on the day of your operation and when to stop eating and drinking in preparation for your surgery.

Once at the hospital, you will be taken to your room with its own en-suite facilities. The Apple Surgical Clinic team will admit you and check that everything is in order to proceed with the operation.

What happens during a gallbladder removal operation?

Mr Agwunobi will remove your gallbladder in a procedure known as a laparoscopic cholecystectomy. This will involve making small incisions in your abdomen and inserting a laparoscope, connected to a special camera, giving magnified views of the internal organs.

Tiny, long instruments are used to reach the gallbladder which is then removed from its liver bed. The small skin incisions will be closed with dissolving sutures (stitches), so there is no need for future removal.

You will be asleep throughout the whole procedure (under general anaesthesia) and you won’t feel anything.

Very occasionally it may not be possible to complete the procedure using the keyhole technique and an open cut has to be made to remove the gallbladder. In our practice, this is very rare and over 99% of operations are completed laparoscopically, even in patients who have had previous open abdominal operations.

What to expect after a gallbladder operation:

  • You will return to the recovery room for close monitoring before being discharged back to your own room. The ward nurses will continue to monitor and support you on the ward to aid your recovery.
  • You may experience some shoulder tip pain, which can be due to the carbon dioxide gas used during the operation to distend the abdomen. This can irritate the diaphragm, which has the same nerve supply as the shoulders, but it should pass off very quickly.
  • Adequate pain control will be provided, as well as anti-sickness medications if you feel nauseous.
  • You may eat and drink a few hours after surgery, starting with small portions.
  • Most patients are able to go home the same day, although a minority may need to stay in overnight for further monitoring.
  • You will be discharged home with painkillers to take for 4 – 5 days.
  • A follow-up appointment will be arranged for you to see Mr Agwubi again in 4 – 6 weeks’ time.
  • Your skin wounds will be dressed with waterproof dressings so that you can have showers at home. These may be removed after 5 days and the stitches will dissolve themselves.
  • Full recovery and return to work should take around 7 – 14 days, depending on the type of job you do.
  • You may be able to drive 7 days after your surgery, or when you feel able to do an emergency stop, but please check with your insurer.

What are potential complications of a gallbladder operation?

Complications are rare and over of 99% of patients have a smooth recovery and see their symptoms resolved.

Very occasionally patients may experience excessive bleeding, infection, injury to the bile duct, or retained stones. These small risks will be discussed with you at your consultation.

Please contact us immediately if you experience any of the following problems during your recovery:

  • Fever
  • Yellow skin or eyes (jaundice)
  • Bleeding
  • Worsening abdominal pain and distension
  • Persistent nausea and vomiting
  • Redness and discharge from one of your wounds

Are there any long-term consequences of not having my gallbladder?

You can live perfectly fine without your gallbladder. Your body will adjust.

In a small minority of patients, there may be an increase in bowel frequency, but this is usually temporary and rarely requires any form of treatment.

Do I need to follow a special diet after my gallbladder operation?

You do not need to follow any special diet after your gallbladder operation. Stick to a healthy, balanced diet as usual, but it may be better to eat smaller portions initially until you are able to manage larger meals.