Advanced, minimally invasive treatments at affordable costs only at Medfin.

Advanced, minimally invasive treatments at affordable costs only at Medfin.

The doctor starts with history taking, followed by clinical or physical examination. This will be followed by blood investigations and imaging techniques that the doctor feels appropriate.

The blood tests may include complete blood count, liver function tests (which will reveal levels of bilirubin which is important in the diagnosis of Gallstones), Lipid profile which reveals levels of cholesterol, HDL good cholesterol which may be causative for the formation of the gallstones.

Other tests may be imaging techniques such as 

  • Abdominal Ultrasound, 
  • EUS (endoscopic ultrasound),
  • Oral Cholecystography,  
  • Hepatobiliary Iminodiacetic acid (HIDA) scan, 
  • Computerized Tomography (CT), 
  • Magnetic Resonance Cholangiopancreatography (MRCP) or 
  • Endoscopic Retrograde Cholangiopancreatography (ERCP).

Gallstones are hard substances formed from the digestive juices present in the gall bladder. The main factor causing the build-up of gallstones is high amount of cholesterol in the bile juice stored in bladder. The diagnosis of gallbladder stones is done using USG Abdomen.

Treatment options for gallstones are:

  • Open (traditional) Cholecystectomy: It’s a common, but still a major surgery with some risks and complications. A large incision is made in your abdomen. The muscle and tissue are pulled back to reveal the liver and gallbladder and then the surgeon removes the gallbladder.
  • Laparoscopic Cholecystectomy: It’s a minimally invasive surgery to remove the gallbladder. 

    The surgeon makes 4 small incisions in your abdomen. Then a tube with a tiny video camera is inserted into your abdomen through one of the incisions. The surgeon with the help of a video monitor sees the site and inserts the other surgical tools through the other incisions in the abdomen. Finally, s/he removes the gallbladder. Later, these small incisions are also sutured. This takes about 1-2 hours. This procedure causes less pain, quicker recovery, smaller wounds and scars, quick return to regular activities and less complications.

The main cause is unknown but is believed to be due to high cholesterol in the bile juice (seen due to an unhealthy diet, obesity, hereditary factors, and smoking). 

Others occur because of increased levels of a pigment called bilirubin (that increases in blood and liver diseases) and other ailments that affect the gallbladder.

If the gallstones are present with no symptoms, the patient is advised to maintain a healthy diet with plenty of fluids, take supplements, and light exercises directed by the doctor.

If the patient is symptomatic there are non-invasive treatments, surgical treatment both open and minimally invasive, or laparoscopic surgery.

Non-invasive Treatments:

In non-invasive techniques depending on the type of gallstone, bile salts can be used to dissolve stones formed due to cholesterol but this cannot be used for gallstones formed due to bile pigments.

 This treatment duration may take longer as some of the stones may be calcified. 

Sometimes shock wave therapy (where shock waves are used to break the stones down into finer pieces) is used to break down the stones followed by administration of bile salts.

ERCP(Endoscopic retrograde cholangiopancreatography) - This is a kind of endoscopy through which an instrument is inserted through the endoscope to remove the stones.

In most of these non-invasive procedures, recurrence is common and hence not successful long term. Gall bladder serves an important function but it is not required for a healthy life. 

Surgical Treatment for Gallstones (Gallbladder Removal)

When the symptoms of gallstones are persistent then surgery to remove the Gallbladder should be considered. There are two types of surgeries open and laparoscopic cholecystectomy.

Laparoscopic Cholecystectomy: In a Laparoscopic Cholecystectomy, the surgeon will make four small incisions in your abdomen. Then a tube that has a tiny video camera is inserted into your abdomen through one of the incisions.

The surgeon with the help of a video monitor sees and inserts the other surgical tools through the other incisions in the abdomen and removes the gallbladder. Later these small incisions are sutured. This takes about 1-2 hours.

Laparoscopic cholecystectomy may not be advisable for all patients, it is for the treating surgeon to decide whether the patient should undergo laparoscopic or open.

1.Overview: A large incision is made in your abdomen below the ribs on the right side in order. The muscle and tissue are pulled back to reveal the liver and gallbladder and then the surgeon removes the gallbladder.

2.Snapshots:

  • Procedure Type: OPEN Surgery
  • Anesthesia: General anesthesia
  • Hospitalization: 2-3 days
  • Procedure time: 1-2 hours
  • Recovery Time: 4-6 weeks

3.Post-Surgical Care: 

  • Keep the wound clean by washing with water and mild soap
  • You may remove the wound dressings and take showers the day after surgery
  • Rest is a must
  • You can try stool softener, but do not soak in bathtub or go swimming. 

4.Advantages of this Procedure: It is generally applicable when there is extensive inflammation, bile duct injury, adhesions and bile duct stones.

Gallstones are more common among:

  • ​Women, especially those who are undergoing hormone replacement therapy or pregnant
  • People with high triglyceride and low HDL cholesterol levels
  • People who are obese, have lost weight quickly, or have had weight loss surgery previously
  • Those who eat a low fiber diet
  • Old age men and women
  • Smokers
  • Individuals with a family history of gallstones

Other conditions that increase the risk are cirrhosis (causing impaired liver function), intestinal diseases (such as inflammatory bowel disease), infections in the bile duct, hemolytic anemias, and diabetes mellitus.

Untreated gallstones may lead to complications such as:

  • ​Jaundice (yellowish skin and eyes)
  • Pancreatitis – Inflammation of the pancreas
  • Acute cholecystitis -the stone blocks the bile duct and causes infection in the gallbladder
  • A complication of infection leading to sepsis 
  • Acute cholangitis –bile ducts become blocked and infected
  • Cancer of the gallbladder

1.Overview: In this procedure, there are 4 incisions made. A tiny camera is inserted along with special surgical tools to see the inside of the abdomen. This helps to remove the gallbladder. Later these small incisions are sutured.

2.Snapshots:

  • Procedure Type: Laparoscopic surgery
  • Anesthesia: General anesthesia
  • Hospitalization: 0-1 day
  • Procedure time: 1-2 hours
  • Recovery Time: 1 week

3.Post-Surgical Care: 

  • Avoid foods that can cause constipation
  • Take complete rest for two days
  • Do no strenuous activities or heavy lifting for 4 weeks
  • Try to walk every day
  • Do not soak as submerging in water increases infection risks
  • Keep the incision clean by taking a shower with soap and water.

4.Advantages of this Procedure: Less pain, quicker recovery, smaller wounds and scars, quick return to regular activities and less complications.

  • Intense pain in the upper abdomen (on the right side) may spread to the back, which may radiate to the and shoulder on the same side.​
  • Nausea
  • Vomiting 
  • Flatulence (gas) and indigestion
  • Diarrhea
  • Darker colored feces and urine

At times, you may not even experience any symptoms, and these may be found on the x-rays or during surgery in the surrounding area.

You may have to undergo the tests as prescribed by the doctor to evaluate the type, size, and location of the gallstone for surgery. 

Patients with other ailments like allergies, liver, and blood disorders are approached in a slightly different manner as compared to those without them. Hence, one must visit the doctor for the best treatment option.

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