Are you experiencing abdominal pain and wondering if it could be related to gallstones? Understanding if when does gallstone need surgery is crucial for timely diagnosis and treatment. The gallbladder’s function, the different types of gallstones, and the indications for surgery all play a significant role in determining the appropriate course of action. Let’s delve into the comprehensive overview of gallstone diagnosis and treatment.
Gallstones, the small, hardened deposits that form in the gallbladder, can be a silent issue unless they block the flow of bile and cause a gallstone attack. This condition can manifest with significant abdominal pain and lead to complications like a gallbladder attack or even gallbladder cancer. While the presence of gallstones—be it cholesterol stones or pigment stones—doesn’t always necessitate surgical intervention, it becomes crucial when accompanied by distressing symptoms or during certain medical situations, such as rapid weight loss or before weight loss surgery.
Overview Of Gallbladder Function
The gallbladder is a small, pouch-like organ nestled just beneath the liver, instrumental in digestion. Its primary role is to store bile—a digestive fluid the liver produces. Inside the gallbladder, bile becomes more potent as water is absorbed, priming it for breaking down fatty foods in the small intestine.
However, this vital process can be disrupted. Gallstones, which are crystalline formations, have the potential to block the pathways, known as ducts, that bile travels through. An obstruction can inflame the gallbladder, leading to symptoms that may last several hours, such as intense abdominal pain, nausea, vomiting, and in some instances, fever, chills, or even jaundice. Other less common indicators include dark tea-colored urine and pale stools.
What is Gallstone?
Gallstones are solid particles that form from bile concentration in the gallbladder or bile ducts. The creation of these particles, termed cholelithiasis, happens when cholesterol, bilirubin, and bile salts balance is disrupted. Despite their tiny size, comparable to a grain of sand, gallstones can grow as large as a golf ball, with varying quantities seen in different individuals.
Symptoms Of Gallstone Issues
Gallstones can trigger a range of symptoms, primarily manifesting as intense upper right abdominal pain. Patients often report associated nausea and vomiting, especially after meals rich in fats. The discomfort can last several hours and intensify post-mealtime indulgence in greasy foods.
|Severe pain in the upper right abdomen, right shoulder, or between shoulder blades
|Nausea and vomiting, particularly after fatty meals
|Fever and chills
|Indicative of inflammation or infection
|Yellowing of skin and eyes, suggesting bile duct blockage
|Urine and stool changes
|Dark urine and pale stools because of bile flow disruption
Types Of Gallstones
Gallstones are crystal-like deposits that form within the gallbladder or bile ducts and can be broadly categorized into two main types: cholesterol gallstones and pigment gallstones. These two types differ significantly in their composition, causes, and the populations they commonly affect. Understanding the differences between these types of gallstones is essential for diagnosis and determining the appropriate treatment course.
Cholesterol gallstones are the most frequently encountered type, forming when the bile has an excess of cholesterol and a deficiency of bile salts necessary to keep it dissolved. Saturated fats and dietary choices play a substantial role in their formation, as do factors such as obesity, lifestyle choices, and rapid weight loss, particularly after weight loss surgery. Incidentally, women, individuals above the age of 40, and those with a genetic predisposition face a heightened risk of developing cholesterol gallstones. Furthermore, certain ethnic groups such as Native Americans exhibit a greater propensity for this type of gallstone.
Pigment gallstones are typically brown or black, forming when bilirubin accumulates excessively in bile, most often due to liver diseases or blood disorders that increase bilirubin levels in the blood. They are generally smaller than cholesterol stones and often emerge from conditions that interfere with bilirubin processing in the liver.
Causes Of Cholesterol Gallstones
Cholesterol gallstones are the result of various physiological factors that disturb the delicate balance within bile, the digestive fluid produced by the liver. These gallstones primarily form due to an excess of cholesterol in the bile, which can stem from different underlying issues.
One such issue is the imbalance of lipids and acids in bile, often caused by excessive cholesterol in the bloodstream. This imbalance disrupts the solubility of cholesterol, leading to the formation of stones. Additionally, diseases that lead to bile acid malabsorption contribute to a decrease in bile acids, thereby increasing the concentration of cholesterol.
Treatment For Gallstone
Gallstones are solid particles that form from bile cholesterol and bilirubin in the gallbladder, leading to a range of potential complications and discomforts. When addressing the treatment for gallstones, the course of action varies based on the stone’s characteristics, an individual’s overall health, and the presence and severity of symptoms. Approaches range from watchful waiting to medications, alternative treatments, and ultimately, surgery. Each option carries its considerations, benefits, and risks, which must be carefully weighed by healthcare professionals and patients.
Observation And Waiting
For those with gallstones that do not cause symptoms—a condition known as “asymptomatic gallstones”— or those who wonder, “If you have a gallstone do you need surgery?” – observation and waiting might be suggested. This non-invasive strategy involves regular monitoring, typically through check-ups and imaging tests, to ensure that no complications arise. Candidates for this approach are usually those who do not experience gallbladder attack symptoms and might have gallstones discovered incidentally.
When surgical options are not viable or a decision is made to address gallstones non-surgically, medications might be the chosen path. Drugs aimed at gallstone dissolution, such as ursodiol or chenodiol, are designed for smaller, non-calcified cholesterol stones. These treatments require a commitment, as the process of dissolving stones can take several months or even years, and there is always the potential for the gallstones to reform post-treatment.
In certain situations, patients may seek or require alternative treatments for gallstones. One such treatment is shock wave lithotripsy (ESWL), which involves using shock waves to break gallstones into tiny pieces that can be passed in the stool. However, this approach is less common today due to the prevalence of recurrence and the success rates of laparoscopic surgery.
Surgery for gallstones, known as cholecystectomy, is usually reserved for individuals experiencing symptoms, repeated gallstone attacks, or complications such as pancreatitis. There are two principal types of gallbladder removal surgery:
- Laparoscopic Cholecystectomy: The preferred and minimally invasive method of gallbladder removal, requiring several small incisions.
- Open Cholecystectomy: Used for complicated cases with severely inflamed gallbladders, involving a larger incision.
Indications for Surgery
For individuals grappling with symptomatic gallstones, surgery is often a critical next step. The consistent manifestation of symptoms, ranging from intense abdominal pain to nausea and vomiting, is a clear indicator that surgical intervention may be required.
Surgery becomes the primary recommendation when less invasive procedures, such as shock wave lithotripsy or medications, do not achieve the desired results. Furthermore, a stone obstructing the bile duct, resulting in severe complications like jaundice or cholangitis, necessitates surgery to relieve the blockage and mitigate risk.
Types of Gallstone Surgeries
When it comes to gallstone removal, there are primarily two types of surgery: laparoscopic surgery, also including robotic-assisted techniques, and open surgery. Laparoscopic cholecystectomy is the most commonly performed gallbladder removal surgery, known for its less invasive approach with small abdominal incisions, use of a video camera, and specialized surgical instruments. Patients benefit from reduced pain, shorter hospital stays, and quicker gallstone removal surgery recovery times.
Preparing for Surgery
Before undergoing gallstone surgery, a thorough physical examination is vital to assess overall health and the viability of the procedure. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) recommends this as a critical step. Pre-operative preparations are crucial and include following the surgeon’s specific instructions, such as fasting and bathing on the eve of the surgery.
Certain medications must be paused before the operation, including:
- Nutritional supplements
- Blood thinning agents
- Immune system affecting drugs
On the morning of the surgery, patients may take approved medicines with a small amount of water, under the guidance of healthcare providers. For those undergoing robotic gallbladder removal, the latest advancement provides a three-dimensional, high-definition view, enhancing precision through surgeon-manipulated robotic arms.
Preventing Gallstone Formation
Gallstone prevention centers on lifestyle choices that support a healthy weight. Staying active through regular physical activities and choosing a diet low in saturated fats may decrease the incidence of cholesterol gallstones, the predominant type. A diet that champions fiber-rich foods while scaling back on refined sugars can be a strategic move in gallstone avoidance.
When medical treatment for gallstones is necessary, a cholecystectomy—surgical removal of the gallbladder—is the most reliable intervention. This procedure offers relief from gallstone attack pains and prevents the recurrence of stones. Although the gallbladder serves a role in the digestive process, its absence typically does not cause serious digestive issues. Some patients may notice temporary changes in their bowel movements, but these alterations generally improve over time without impacting overall health.
What size of gallstones need surgery?
Typically, gallstones that are larger and obstruct the bile ducts are more likely to require surgery. When gallstones block the flow of bile, it can lead to severe pain, inflammation, and potentially serious complications such as infection or damage to the gallbladder or bile ducts.
The decision to perform surgery for gallstones is not solely based on their size, but rather on the symptoms they cause and the potential risks associated with leaving them untreated. In general, if gallstones are causing recurrent or severe symptoms, surgery may be recommended.
How long can you go with gallstones before surgery?
The duration for which a person can go with gallstones before requiring surgery varies based on individual circumstances. If the gallstones are symptomatic, causing severe abdominal pain, nausea, or vomiting, or if complications like inflammation or infection arise, prompt surgical treatment might be recommended.
Can you have gallstone surgery without removing the gallbladder?
Yes, it is possible to have gallstone surgery without the complete removal of the gallbladder. In some instances, such as when stones are lodged within the common bile duct, a procedure known as endoscopic retrograde cholangiopancreatography (ERCP) can be performed to remove the stones. This approach allows for the treatment of the immediate issue without necessitating gallbladder removal. Help from orthopedic surgeons can also be needed for some of these procedures.
About The Author
Christian was born in a Group Health hospital in Washington state and holds both American & Canadian citizenship. Christian is the head of our diagnostic & ambulatory surgery department for our Canadian…