“I don’t want to undergo surgery. I’m scared that the surgery will be more dangerous than the disease.” “If this happened because my diet is unhealthy, can’t I just fix my diet and take care of this?”
These are some of the questions we hear often at our center while disclosing a diagnosis of gallstones. Most patients are reluctant to undergo surgery, a very understandable and valid response to the situation. You might even have stumbled upon this page because you’ve recently been diagnosed with gallstones and have been advised surgery. This article is for you to understand a little bit more about what is happening in your body and what the standard medical practice towards the same is. Dr. Rengan is an experienced laparoscopic Surgeon who has been performing laparoscopic gallbladder surgery for the past 30 years.
First of all, let’s try and understand what gallstones are and how they cause problems.
Gallstones are some solidifications that form in your gallbladder. Most often, these stones form after a long period of abnormal proportions of gallbladder contents. Many reasons exist for this; including long-standing infection, fatty and carbohydrate-rich diet, obesity, estrogen levels (like in pregnancy), abnormal biliary tract structure, etc,. Broadly; gallstones can be classified into cholesterol stones, bilirubin stones, and mixed stones based on their composition.
What happens after these stones form?
Most small stones, if few in number, don’t cause any pain or problems. Most people might not even know that they have them. At this stage, they might only be picked up on a routine medical exam or on medical imaging for some other issue. This is when aggressive diet/lifestyle changes and medications can help resolve the condition. Despite this, recurrence is common once the medicines are stopped.
As the stones grow bigger and more in number, more issues start presenting themselves. Gallstones can form anywhere along the biliary tract, and the stones that form in the gallbladder itself are capable of moving into the branches of these tracts as well. In the following image, you can see that the biliary tract connects to 3 main organs from the gallbladder — the liver (from where it receives bile), the duodenum (to where it secretes bile) and the pancreas (which uses the same duct system as the gallbladder to send its secretions to the duodenum).
Depending on the location of the gallstones, different problems can arise:
In the gallbladder itself (Cholelithiasis):
Gallstones can cause inflammation of the gallbladder (cholecystitis). This causes pain that lasts for a short while but recurs periodically (chronic cholecystitis); or sudden severe pain accompanied by fever, nausea, and vomiting (acute cholecystitis). Pain is usually at the right upper abdomen but can spread to the back, shoulder, or entire abdomen.
Even in mild cases, the symptoms might be worsened after meals or drinking alcohol. It can be accompanied by bloating and uneasiness. The stones can dislodge and move elsewhere as well. Chronic gallstones in the gallbladder may lead to cancer of the gallbladder (0.1% cases). If the gallstones erode through the wall of the gallbladder from constant inflammation or irritation, it can abnormally join the duodenum (cholecystoenteric fistula) and lead to a small bowel blockage, an emergency condition.
In the common bile duct (Choledocholithiasis):
Gallstones can obstruct the bile duct and lead to severe inflammation of the bile duct (cholangitis). It is characterized by fever, jaundice, and abdominal pain. This can sometimes rapidly evolve to cause septic shock (a dangerous condition in which organ systems of the body start shutting down one by one if untreated) and mental confusion. In the elderly, sometimes no warning signs might be seen and they might just collapse suddenly.