Mr Iain Jourdan FRCS
Specialist Laparoscopic and Colorectal Surgeon
Dealing with symptomatic gallstones
Gallstones consist of crystals of cholesterol mixed with bile pigments. Any imbalance in the constituents of bile can result in the formation of gallstones. It is likely that the high fat diet in the Western world contributes to the increasing incidence of gallstone disease. About 1 in 3 women, and 1 in 6 men, form gallstones at some stage in their lives. They become more common with increasing age and can also occur during pregnancy due to hormonal changes.These can vary in size from sand or gravel to larger stones measuring several centimetres in size.
Gallstones develop in the gallbladder which is a sac-like structure suspended from the under surface of the liver, underneath the right lower ribs. Occasionally the stones escape from the gallbladder and block the bile duct.
Gallstones can present in various ways, though a proportion cause no symptoms whatsoever and are picked up on routine ultrasound scans. Upper abdominal pain is the most common symptom, which is characteristically very severe, lasts for several hours and requires strong painkillers to provide relief. Fatty foods can often precipitate an attack which generally occurs at night after an evening meal. Gallstones can also cause indigestion like symptoms. Occasionally the pain can be confused with angina or a heart attack. If gallstones migrate from the gallbladder they can cause jaundice, pancreatitis and even bowel obstruction.
Ultrasound scans are the most sensitive method of detecting gallstones, but plain X-rays and CT scans can also pick up stones. A proportion of gallstones are so small that they are not seen on conventional scans.
Gallstones discovered incidentally in patients who have no symptoms do not require treatment. However if they are causing symptoms, or presenting with complications, treatment is advised. Gallstones do not often cause serious illness and the majority of patients have uncomplicated keyhole surgery to remove the gallbladder. Occasionally gallstones can cause pancreatitis which is a serious condition that can be life-threatening.
The gold standard treatment is removal of the gallbladder with keyhole surgery (laparoscopic cholecystectomy). For this procedure the gallbladder is removed under general anaesthesia, and four small holes are made to introduce a camera and instruments to dissect and remove the gallbladder from the liver.