What Are Gallstones?
Gall bladder is a small organ in the shape of a “sac” situated just beneath the liver. The primary role of gall bladder is storage of bile made by the liver with an average capacity of 50ml.
Gallstones (often called cholelithiasis by doctors) are formed in the gall bladder and are made up of cholesterol particles, calcium deposits and other substances found in bile.
They can vary in size, constitution, compactness and severity of symptoms — but for the most part, they are all caused by the same things and treated very similarly.
Symptoms of gall stones
- Gall stones symptoms are different for every person and can vary in intensity or duration.
- When gall stone temporarily blocks the bile duct, patient experiences pain in the right upper side of abdomen for about 30 minutes, known as biliary colic. Some patients can feel pain in the back in between shoulder blades
- The biliary colic often occurs in the night and it is a self-limiting pain.
Complications of gall stones
Acute cholecystitis: A serious condition associated with severe infection of gall bladder. Severe pain right upper abdomen persisting for many hours.
Rupture of gall bladder: when the gall stones completely block the cystic duct, there is accumulation of pus in gall bladder. Sometimes the gall bladder wall can rupture due to necrosis especially in diabetics.
Jaundice: When the gall stones dislodge and move into the bile ducts, it blocks the flow of bile into the intestines. It results in accumulation of bile in body causing jaundice.
Pancreatitis: When the stones from gall bladder slip into the pancreatic duct, it blocks the flow of pancreatic juice resulting in life threatening condition called pancreatitis.
Cancer of gall bladder: When the stones are present for a long time and the size is more than 2cm, it can cause gall bladder cancer. It is the most dreadful complication though the incidence in approximately 1%.
Treatment of Gall Stones
The only treatment for gall bladder stones is removal of the gall bladder through laparoscopic surgery. Dr. Kapil Agrawal has an extensive experience of performing laparoscopic cholecystectomy (removal of gall bladder) and he has done more than 3000 laparoscopic removal of gall bladder both by traditional and single port laparoscopic surgery
Conventional or traditional laparoscopic surgery In traditional laparoscopic surgery, 4 small incisions are created in the abdomen. Through one of these ports or incisions, a long, thin, tube like video camera attached to telescope is inserted. The images are projected on the monitor. Long, thin instruments are inserted through other holes. Dissection and removal of gall bladder is carried out by looking at the images transmitted through the camera.
Single port laparoscopic cholecystectomy
Single incision laparoscopic surgery or single port laparoscopic surgery is the most advanced form of minimal form of laparoscopic surgery.
Very few surgeons are performing single port surgery as it has an advanced learning curve and there is very restricted freedom of movement with all instruments.
The procedure is becoming increasing popular as it a virtually scar less surgery. It means no visible scar is present post-surgery.
The entire surgery is carried out with a 2 cm incision placed into the umbilicus, thereby making the scar almost invisible. The patient experience little pain or discomfort and recovery is much faster after single port laparoscopic surgery.
The technique is focused on placing the scar in such a manner that it is completely hidden and invisible. Apart from better cosmesis patient has better recovery with fewer complications.
The patients are usually discharged within 24 hours of surgery. if the patient is able to tolerate diet, they can be discharged on the same day
The patient is encouraged to walk as much as possible from the next day of surgery. he can start taking normal, non-oily meals and can carry normal routine activities depending upon their comfort levels. They can resume their office in 5-6 days and start lifting weights after 10 days of surgery.
We perform single port surgery in about 90% of our patients if the patient wishes to under go single port surgery. we usually do not perform single port surgery if the patient is severely obese, had multiple abdominal surgeries or the patient has acute infection of the gall bladder.
The patient is advised non-fatty diet for a period of 2-3 weeks. During this time, the body gets adjusted to work without gall bladder. After this patient can start taking normal diet comfortably but low-fat diet is always advisable.
Only 1-2% patients complain of bloating of abdomen following gall bladder surgery. seldomly, patient can even have diarrhea. In majority of patients, these symptoms settle down with time. Our dieticians or nutritionist work very closely to identify foods which trigger bloating of abdomen and certain changes in food habits solve this problem once and for all.
There are no medicines which can cure gall bladder stones. But if tiny stones are found in gall bladder after a prolonged illness, medicines can certainly help in dissolving them in few patients. Apart from that, use of medicines for dissolution of gall stones has very poor results.
Although there is no definitive reason as to why the gall bladder stone occurs, certain conditions which predispose to gallstone formation are:
Risk Factors for Formation of Gall Stone
- Females especially after the age of 40 years
- Overweight or obesity
- Rapid weight loss especially after crash diets.
- Certain medications like OCPs (oral contraceptive pills), hormone replacement therapy,
- Lack of physical activity