By Dr. Purnendu Roy (MS, FRCS, FICS)
Founder
& Chief Laparoscopic Surgeon, Genesis Hospital, Kolkata
Having
practiced as a general and laparoscopic surgeon for more than three decades, a
great many of my daily consultations involve queries that come down to the same
thing: "Doctor, I've been found to have gallstones, but I'm not suffering
from any serious pain right now. Do I really have to go under the knife?"
This
fear is understandable. After all, "surgery" is a worrisome word, and
as a healthcare professional, my goal is to make this change easier for you to
cope with. Let me explain the function of the gallbladder, the origin of the
stones, and in what instances a gallbladder stone
operation becomes necessary.
What Are the Functions of the Gallbladder?
To find
a solution, we must look into the problem. The gallbladder is a small,
pear-shaped organ located below your liver on the right side of the abdomen.
While the liver produces bile (a greenish digestive fluid), the gallbladder
stores this liquid.
Upon
eating fatty or oily foods, the gallbladder contracts and squeezes its
concentrated contents into your intestine, enabling the digestion of dietary
fats.
[Liver
Produces Bile] ➔
[Gallbladder Stores & Concentrates It] ➔ [Squeezes into Intestine to
Digest Fats]
Due to
some chemical imbalance, the bile inside your gallbladder may start to
crystallize, forming particles ranging in size from a speck of dust to a golf
ball. There are usually too many cholesterols and/or bilirubins in this liquid,
which forms the basis for these solid objects.
"Gallstones in a Silent State" – The Truth
Behind the Term
Patients
who have been diagnosed with silent stones usually discover the condition
accidentally while undergoing abdominal ultrasound imaging in connection with
another issue. These stones are often referred to as asymptomatic.
However,
in case a gallstone blocks the exit canal of your gallbladder, things may
quickly spiral out of control. A complete blockage of this passage results in
the following conditions:
·
Biliary
colic is the occurrence of intense pain felt in the upper right part of the
abdomen. It sometimes radiates to the back or shoulder blades.
·
Cholecystitis
refers to acute irritation or infection of the gallbladder wall, causing severe
abdominal pain and symptoms such as nausea, vomiting, and fever.
Why Not Remove Only the Gallstones and Preserve the
Organ?
This is
the first question that comes to mind upon being diagnosed with gallstones. Why
remove the whole organ if the stones are what causes problems?
As a
surgeon, I completely understand your logic. However, in gastroenterology, we
always deal with root causes rather than symptoms. And the fact of the matter
is, the process of forming gallstones is irreversible. In other words, once the
organs start producing solid objects inside it, your bile will stay chemically
unstable indefinitely, or its muscle layers will remain unable to contract
properly.
In case
we attempted a minimally invasive operation to remove the stones, two major
complications would arise:
·
Relapse: Since the mechanism responsible
for stone formation is unaltered by simply removing the stones, you'll likely
have to deal with the same painful episodes within months or even a year later.
·
Formation
of scar tissue:
By operating inside your gallbladder, we inevitably damage the walls and cause
them to heal with scar tissue, which complicates any possible future
operations.
Thus, to
completely eliminate the condition forever, your best option is to remove the
entire gallbladder since your body adapts perfectly well without this organ.
What About Stones That Escape into the Bile Duct?
In one
particular case, stones can indeed be removed surgically, although it calls for
an entirely different method.
When a
stone gets out of your gallbladder and travels down into the common bile duct
(the main passageway of bile to the intestines), it can block the whole
digestive system, resulting in jaundice and pain.
To fix
the problem, we need to employ a specific advanced endoscopic technique called
ERCP (Endoscopic Retrograde Cholangiopancreatography). Under anesthesia, an
endoscope (a thin, flexible pipe with a camera attached) is passed down the
patient's mouth, esophagus, stomach, and small intestine until the bile duct
opening is identified. Next, a small basket or balloon is introduced into this
pipe and used to extract the stone and withdraw it.
Treatment
Protocol. If a person has a lodged stone, ERCP is first done to clear the
passage and preserve the functioning of the pancreas and liver. Then, depending
on the doctor's recommendations, the laparoscopic operation to remove the
gallbladder is scheduled.
Why Oral Medications Can't Solve the Issue
Permanently
The most
commonly asked questions at Genesis Hospital include whether gallstones can be
dissolved using some oral medication or herbal remedy.
Although
oral bile acid can occasionally resolve gallstones in some patients, the chance
of success in this procedure is exceedingly small. Besides, even if it worked,
it could only apply to small cholesterol stones, and this treatment requires
several months or years to produce a result. What's worse, once you stop taking
the pills, the stones grow back.
Also,
calcium-containing and/or pigmented gallstones are impervious to medical
treatments of this type. Attempts to get rid of these stones with dietary
restrictions and cleanses can be extremely risky, possibly forcing a stone out
of the gallbladder and into the common bile duct, thus blocking it and causing
jaundice or acute pancreatitis.
Gold Standard Treatment for Gallstone Problem:
Laparoscopic Cholecystectomy
However,
when symptoms do manifest, it would be wise to act sooner rather than later
since waiting would only exacerbate the potential complications. The most
reliable course of action in such a case would be a gallbladder stone operation.
Medicine
has developed considerably during the years. Nowadays, there is no need to
undergo major abdominal cuts associated with open surgeries of the previous
century. Instead, we conduct laparoscopic cholecystectomies.
1.
Keyhole cuts: 15 minutes or less.
During
the operation, the surgeon makes 3 to 4 small incisions (less than 1 cm in size
each).
2.
Laparoscope insertion: Diagnose.
A thin
tube, which is a laparoscope fitted with a high-definition camera and capable
of transmitting images in real-time, is introduced through the keyholes. You
will see a highly magnified image of your inner organs on a display screen.
3.
Excision of the gallbladder: Surgical skill.
Using
specific devices, the surgeon separates the whole gallbladder and removes it
together with the stones through one of the keyholes.
Life Without Gallbladder After Its Removal: How Does
Your Body Function?
Another
common question many people have concerns how one's health condition changes
after removal of a problematic organ. There is no reason to worry, though; your
liver continues producing the bile just as effectively as before. The main
difference is that it goes directly from your liver into the small intestine
without passing through the gallbladder anymore.
The
majority of individuals recover from the procedure and return to their normal
activities in seven days. Although you may want to avoid heavy and fatty foods
in the first two weeks after the surgery, everything else should remain
perfectly fine.
If you
suffer from recurrent attacks of abdominal pains caused by gallstones, don't
hesitate any longer. Consult with Dr. Purnendu Roy
at Genesis Hospital.
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