One of the most common questions encountered by surgeons in their practice is this: “Doctor, I have gallstones; do I need to undergo Surgery?” A few others include “Do gallstones disappear with pills?”

“My gallstone was 0.5 cms in size, then it grew to 1 cm and now, it is 0.7 cms….Why is it so doctor ?“ , “is it mandatory to remove the gallbladder or can removal of the stone alone address the problem?”, “Doctor, I heard from my neighbor that gallbladder removal can cause problems later in life, is that true?” and so on. In this article, I will try to address some of these vexing questions.

What is gallbladder?

The gallbladder is a pear shaped organ located in the right upper abdomen. It acts as a reservoir of bile and aids in digestion by pumping out bile when food enters into the small intestine. Gallstones occur as a result of solidification of bile components. The two main types of gallstones are cholesterol stones (80%, yellow in color) and pigment stones (black: due to infection).

Causes of gallstones
1. Genetics, ethnicity

2. Gender (more common in women)

3. Excessive cholesterol in bile (Diet, dyslipidaemia, drugs incl. oral contraceptives & fibrates, obesity)

4. Decreased contractility of gallbladder

5. Blood disorders (Haemolytic Anaemias)

6. Rapid weight loss (esp. following bariatric surgery)

How are gallstones diagnosed?
Diagnosis of this condition is usually done by ultrasound study of the abdomen in conjunction with physical examination and blood tests. Sophisticated techniques including EUS (Endoscopic Ultrasound), CT scan, MRCP (Magnetic Resonance CholangioPancreatography) may be required to diagnose gallstones when the previous evaluation is inconclusive or having suspicion of complications. Cholescintigraphy (HIDA Scan) is another useful test to assess contractility of the gallbladder. It should be noted that only an approximate estimate of the size of the gallstone is possible with these investigations. Moreover, the size of the gallstone doesn’t always show a correlation with symptoms. Those who have small gallbladder stones are likely to develop complications like pancreatitis, whereas those with larger stones have a propensity to develop cholecystitis.

 

Gallbladder Stones Treatment – Are there any non-surgical options available?
Yes, there are some, but unfortunately none of them are effective. Pills like Ursodeoxycholic acid are useful only in patients with small cholesterol stones and once patients stop taking the pills, the gallstones recur. Hence, they are usually considered only in patients unfit for surgery. Other options include lithotripsy and contact dissolution therapy, which are not used widely in the management of gallstones.

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