What is the treatment for gallstones?
Bradford R. Keeler, MD, FACS, is a general surgeon specializing in diseases of the breast, colon, thyroid and parathyroid glands, gastrointestinal system, skin, vascular system, and hernia repair using traditional and minimally invasive approaches. To make an appointment with Dr. Keeler, Dr. Collins, Dr. Blomquist, or Dr. Schmidová, call the Banner Health Clinic Specializing in General Surgery at (970) 669-3212.
Question: What are gallstones and how are they treated?
Answer: Gallstones grow inside the gallbladder, a sac near the liver that stores and releases bile. Bile is a clear yellow liquid that helps people digest fatty food. Gallstones form when bile hardens into one or more stone-like deposits and can range in size from a few millimeters to several centimeters.
There are two main types of gallstones: cholesterol predominant stones and pigment stones. Mixed-type stones (cholesterol and pigment together) are also common. Cholesterol gallstones are the most common and are composed of cholesterol deposits. Pigment gallstones are the result of excess bilirubin in a person’s bile. Although it is not completely clear why gallstones develop, their formation is thought to be the result of too much cholesterol or bilirubin, a substance found in bile, or due to a gallbladder that does not function properly. You can form cholesterol gallstones even when your blood cholesterol is normal. In other words, you don’t have to have high cholesterol to make gallstones. Anybody can get gallstones, but they are more common in women and people who are overweight.
Gallstones are quite common. In fact, many people go through life not knowing they have gallstones because they do not have any clear signs. Since gallstones may not cause any symptoms, there is usually no need to treat them unless they block either the cystic duct (the tube leading out of the gallbladder) or the common bile duct which drains bile from the liver. If this happens, people often feel sharp pain in the right upper part of the abdomen or pain below the breastbone in the upper abdomen. The pain can also travel around the right side of the abdomen to the flank or right shoulder blade. Sometimes people just have back pain without any abdominal pain. Typically, pain occurs within an hour after eating a meal, but can occur at any time once the gallbladder becomes inflamed or chronically scarred. Having a fever with gallbladder related pain may be a sign of a gallbladder or bile duct infection. Pain from gallstones can last from just a few minutes to several hours. Symptoms of bile duct obstruction can be dark urine, light-tan colored stools, or jaundice (yellowing of the skin or the white part of your eye) in addition to the abdominal pain.
Some individuals also may have an abnormally contracting gallbladder that can create classic right upper abdominal pain after meals without having gallstones. This pain can be every bit as bad as the gallbladder pain caused by gallstones.
If a person has symptoms, the gallbladder may need to be removed by having an operation called cholecystectomy. My partners Jerome S. Collins, MD, FACS, Thomas M. Blomquist, Ph.D, MD, FACS, and Karin Schmidová, MD and I offer this procedure at McKee Medical Center and Skyline Surgery Center. In most cases (about 99 percent of patients), gallbladder removal is accomplished using a laparoscopic (minimally invasive) approach.
Often times, this can be completed as an outpatient procedure. At McKee Medical Center, my colleague, Dr. Blomquist, and I also offer minimally invasive cholecystectomy utilizing a robotic-assisted device through a single incision at the belly button. These minimally invasive approaches offer the advantage of less pain, quicker recovery, and fewer complications than a traditional open surgical approach to gallbladder removal.
There are also medications designed to dissolve gallstones; however, these are not used very often as they are typically ineffective, or may take months or even years to work. Additionally, the gallstones usually reform once the medications are stopped, and there are a number of side effects associated with these medications. They are used when patients either refuse surgery or are considered too high risk for an operation. Stone fragmentation with high frequency sound waves has been utilized in the past, but due to risk of stone passage into the common bile duct draining the liver and obstruction of this duct, this method is not utilized any longer.
If you feel you are having abdominal pain that is related to your gallbladder, contact your primary care provider who can arrange for simple, non invasive testing to be done to determine if you may benefit from gallbladder removal.