Treatment for gallstones
Symptomatic Management: Treatment of symptoms of pain with injectable or oral painkillers. No medical therapy is available for gallstones as such which can cure the disease. Though, injectable or oral antibiotics and supportive medications are available for treating the infection.
Surgery: Surgery to remove the gall bladder is the only way to cure gallstones. this can be done by conventional (open) method or a well established endoscopic (laparoscopic) method which is now the gold standard. The surgery is called Laparoscopic Cholecystectomy (Lap.Chole). For this operation, the surgeon makes few tiny cuts in the abdomen and inserts surgical instruments and a miniature telescope with a mounted video camera in the abdomen. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and the tissues. While watching the monitor, the surgeon uses the instruments to carefully separate the gallbladder from the liver, ducts and vessels. The gallbladder is then removed through one of the small incisions. Recovery usually occurs within a day in the hospital. Because the abdominal muscles are not cut during the laparoscopy surgery, patients have less pain and fewer wound complications. If the surgeon finds any difficulty in the laparoscopic procedure, the operating team may decide to switch over to open surgery. It is called open surgery because the surgeon has to make 5 to 8 inch incision in the abdomen to remove the gallbladder. Open surgery has faded into the background with the laparoscopic technique providing significant advantages and ease for the patient. Improving technology day by day is making it safer and accurate for even complex cases and situations.
What if a stone slips into the Common Bile Duct (CBD)
Slippage of the stones in CBD may cause pain or jaundice or both. This situation requires an endoscopy (ERCP) for removing the stone. This should be preferably done before the surgery. However, it may also be done after the operation.
How do we confirm if a stone is in the CBD?
Sometimes a stone in the CBD may not show in an ultrasound, however patients may have symptoms which are indicative of the same. In this event the patient requires Magnetic Resonance Cholangiopancreatography (MRCP – an MRI Scan) which shows the presence of stones in the common bile duct.
Do you only remove the stones from the gallbladder?
No, the gallbladder is removed with the stones. The disease is in the wall of the gallbladder.
What is ERCP?
The physician may use Endoscope for removing CBD stones before the gallbladder surgery. Once the endoscope is in the first part of the small intestine, it locates the affected bile duct. An instrument on the endoscope is used to capture the stone in a tiny basket and removed with the endoscope. Biliary stent may be needed and placed in the common bile duct (CBD). This may be removed endoscopically after few weeks
Non Surgical Treatment
Non surgical approaches are used only in special situations such as when a patient’s condition is not fit for anaesthesia and surgery. This does not cure the patients as it only provides symptomatic relief.
Do people need their Gallbladders?
Yes, we all need gallbladder to store bile, but only when it is functioning normally! Gallbladder is a storage organ like the store in our house. It also concentrates the bile. When diseased, it starts over concentrating the bile and forming the stones. Another mechanism of the gallbladder is that it distends like a balloon. Diseased Gallbladder may be contracted or thick walled may not distend to accommodate bile. Remaining space may get occupied with the produced stones. Fortunately, the Gallbladder is an organ that people can live without. Loosing it wont require much change in diet. Once the gallbladder is removed, bile production remains unaffected as it is produced in the liver and it is only the bile which helps in digestion of food and gallbladder has no role to play in that.