Treatment of Symptomatic Gallstones

Lack of exercise, high calorie and low-fiber nutrition as well as obesity are risk factors for the development of gallstones what explains the high incidence of gallstones in our society.

Even though most patients carrying gallstones are asymptomatic, about a quarter of all patients with gallstones eventually develops symptoms such as a biliary colic, an inflammation or even perforation of the gallbladder.

Symptoms Associated with Gallstones

Typical and characteristic symptoms of gallstones are well recognized pain in the right upper quadrant that might radiate to the back and that lasts more than 15 minutes. These attacks can be triggered by fatty food, the pain can come in waves or be constant and cramp-like and can often be associated with nausea or vomiting. If gallstones leave the gallbladder and get into the bile duct, they can get stuck and the bile is retained back to the liver, what can result in jaundice (yellow eyes and skin), a decoloration of the stools, and dark urine. In this case, the stones in the bile duct should be removed endoscopically prior to the operation. This can be accomplished by our colleagues from the Department of Gastroenterology.

Gallstones can also cause an inflammation of the gallbladder that might be associated with right upper quadrant pain, fever, and shivering.

If symptoms are not very specific, it can be indicated to rule out other pathologies e.g. by gastroscopy, colonoscopy, CT, or MRI scan.

Minimal Invasive Removal of the Gallbladder

When gallstones are causing symptoms, the removal of the gallbladder together with the stones is generally recommended. The removal of the gallbladder is one of the most common surgical procedures in our institution and is carried out by a minimal invasive, laparoscopic procedure called laparoscopic cholecystectomy.

Four 5-10mm incisions are required to introduce CO2 gas, a camera and instruments into the abdominal cavity to perform the procedure under perfect visual control. This procedure takes about 20 to 45 minutes and can usually be carried out even in cases of an acute inflammation of the gallbladder. Open surgery, like performed to remove the gallbladder in the past, is necessary only in very rare cases.

Alternative Options

While alternative procedures like medical dissolving or disintegration of gallstones by impulse waves was tried in the past, surgery is nowadays the standard treatment also because it became a routine procedure that can be carried out with very little risks and it prevents patients from recurrent stones as they are frequently seen e.g. after medical dissolving.

Removal of the Gallbladder to Prevent the Development of Gallbladder Cancer

Certain alterations of the gallbladder are associated with an increased risk to develop rare gallbladder cancer, that is usually associated with a poor prognosis. This has been observed in patients with a calcification of the gallbladder wall, in patients with stones with a diameter bigger than 3cm (even when they have no symptoms), and in patients with polyps within the gallbladder bigger than 1cm. For these patients, a removal of the gallbladder should be recommended. We are happy to give you our advice.

After Removal of the Gallbladder

After minimal invasive, laparoscopic removal of the gallbladder, our patients usually stay in the hospital for two nights before they can be discharged back home. In case of an acute and significant inflammation, it can be necessary to continue antibiotics for a few days postoperatively.

Patients start on a normal diet on the evening after surgery and we recommend to avoid very fatty food for the first two weeks after surgery, as this can lead to diarrhea or bloating early after surgery in some patients.

Depending on your profession you are back at work 1-2 weeks after surgery.

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