Laparoscopic surgery

Gallstones (cont'd)

 

Your doctor may order the following blood tests:

gall2.jpg

 

Treatment

SURGERY

Some people have gallstones and have never had any symptoms. The gallstones may not be found until an ultrasound is done for another reason. Surgery may not be needed unless symptoms begin.

 

 

 

 

 

In general, patients who have symptoms will need surgery either right away, or after a short period of time.

  • In the past, open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. However, this is done less often now.
  • A technique called laparoscopic cholecystectomy is most commonly used now. This procedure uses smaller surgical cuts, which allow for a faster recovery. Patients are often sent home from the hospital on the same day as surgery, or the next morning.

Endoscopic retrograde cholangiopancreatography (ERCP) and a procedure called a sphincterotomy may be done to locate or treatgallstones in the common bile duct.

 

MEDICATION

Medicines called chenodeoxycholic acids (CDCA) or ursodeoxycholic acid (UDCA, ursodiol) may be given in pill form to dissolve cholesterol gallstones. However, they may take 2 years or longer to work, and the stones may return after treatment ends.

Rarely, chemicals are passed into the gallbladder through a catheter. The chemical rapidly dissolves cholesterol stones. This treatment is not used very often, because it is difficult to perform, the chemicals can be toxic, and the gallstones may return.

LITHOTRIPSY

Electrohydraulic shock wave lithotripsy (ESWL) of the gallbladder has also been used for selected patients who cannot have surgery. Because gallstones often come back in many patients, this treatment is not used very often anymore.

Expectations (prognosis)

Gallstones develop in many people without causing symptoms. The chance of symptoms or complications from gallstones is low. Nearly all patients who have gallbladder surgery do not have their symptoms return (if the symptoms were actually caused by gallstones).

Complications

Blockage of the cystic duct or common bile duct by gallstones may cause the following problems:

Calling your health care provider

Call for an appointment with your health care provider if you have:

  • Pain in the right upper part of your abdomen
  • Yellowing of the skin or whites of the eyes

Prevention

There is no known way to prevent gallstones. If you have gallstone symptoms, eating a low-fat diet and losing weight may help you control symptoms.

References

1.       Siddiqui T. Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a meta-analysis of randomized clinical trials. Am J Surg. 2008;195(1):40-47. [PubMed]

2.       Chari RS, Shah SA. Biliary system. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery.18th ed. St. Louis, Mo: WB Saunders; 2007:chap. 54.

3.       Afdhal N. Diseases of the gallbladder and bile ducts. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap. 159.

Review Date: 7/6/2009.

Reviewed by: George F. Longstreth, MD, Department of Gastroenterology, Kaiser Permanente Medical Care Program, San Diego, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

 

A.D.A.M., Disclaimer


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