Gallbladder Stones treatments
Gallbladder stones constitute one of the most common causes of abdominal pain requiring Hospital admission. Therefore represents a major source of healthcare system expenditure. The definitive treatment of symptomatic or complicated Gallbladder stones is cholecystectomy (removal of gallbladder). The introduction of keyhole surgery and its availability with the less-invasive alternative to the open surgical procedure changed the way we look at asymptomatic (Incidentally found/Silent) gallstone disease.
Gallstonedisease represents a major health problem, with about 10% to 15% of the adults of the Western population. According to population based studies, majority of patients with gallstones will remain asymptomatic (the so-called “silent gallstones”) with only 1% to 4% of them presenting symptoms per year. Gallbladder stones are commonly seen in obese female patients in their fourth decade of life.
History of Gallbladder stones treatments
It is important to understand the natural history of silent Gallstones in order to draw conclusions about their management. Several studies from the 1980s established the innocuous nature of asymptomatic Gallstones when subjected to long-term follow-up. However, much controversy still exists about the role of silent Gallstones in Gallbladder cancer.
Most of the Western population with silent gallstones will remain symptom free throughout their lives and do not require any treatment. The rates of conversion of silent gallstones to symptomatic gallstones varies within a range of 10% to 18% in 10- to 15-year follow-up, and with an annual risk of developing biliary pain of 1% to 4%.Biliary pain is the principal symptom of gall bladder stones occurring the right upper abdomen with radiation to back. This is aggravated by fatty food and can be associated with nausea.
Should we operate on asymptomatic gallstones ?
With the introduction of keyhole surgical technique for gall bladder removal (Laparoscopic cholecystectomy) and due to its less invasiveness people changed the way they look at this disease. Laparoscopic cholecystectomy became the standard treatment of gallstone disease. However, laparoscopic cholecystectomy still carries a 1% risk of bile duct injury,a 3% risk of bile leaks, and a 1% or 2% risk of wound infection. When considering the complications, one must also consider the complications associated with general anaesthesia as well.
Following groups of patients are considered to be high risk, as they are more prone to get complication with gall stones.
- Patients with diabetes mellitus
- Patients awaiting solid organ transplants
- Patients with Sickle cell disease
These patients with gallstones are advised to undergo surgery even if they have silent stones. Diabetic patients are at an increased risk of getting infection of the gallbladder when there are stones.
This cancer risk has been estimated to be increased as much as fourfold in the presence of gallstones and about 80% to 90% of the patients with gallbladder cancers have gallstones. Large stones>3 cm have showed stronger association with Gallbladder cancer.
For general populations, prophylactic cholecystectomy is not indicated to prevent gallbladder cancer. Nevertheless, individuals with>3 cm gallstones might benefit from a more aggressive approach,especially given the fact that gallbladder cancer usually presents at an advanced stage with poor survival.
Dr Udaya Samarajeewa MBBS, MD- Surgery, MRCS (Eng.)
Consultant General Surgeon