GALL STONES

The gall bladder is an approximately 12 cm long pear-shaped sac under the liver – inside the abdomen (tummy) just below the right rib (costal) margin.

It is a reservoir holding bile & ejecting it into the intestine to help digestion.  This is not an important function & its removal does not produce any noticeable or detrimental effect – a little like the appendix.   

Stones can form in gall bladders that are not working properly & by the time stones appear the gall bladder is unlikely to be working at all.  Stones can be of various sizes; 5 – 6 cm in diameter or tiny sand-like grains or a combination of both.  Some gall stones are “silent”, i.e. do not produce any symptoms at all throughout life.    Unfortunately some gall stones produce symptoms; at best they cause cramp-like pain felt in the middle of the upper part of the abdomen – referred to as “biliary colic” – especially after eating fatty or oily foods which has the effect of making the gall bladder contract (go into spasm).  This may also be accompanied by nausea & vomiting.  A more serious effect is infection of the gall bladder with bacteria – known as acute cholecystitis.  This can cause a severe illness with pain felt over the gall bladder area (just under the rib cage on the right), a high temperature, vomiting etc. & often requires admission to hospital for a number of days.  Once this happens it can occur again.

A still more serious complication of gall stones is a knock-on effect on the pancreas (a gland in the back of the abdomen) causing infection referred to as acute pancreatitis.  This can be a life-threatening condition.   It is for the above reasons that whenever gall stones produce a symptom, however trivial, (or in young patients who have not had any symptoms) surgical removal of the gall bladder , i.e. cholecystectomy is advised.  The operation involves removing the whole of the gall bladder rather than just the stones because these will re-form again.

The current standard method is to use a laparoscopic technique (key-hole surgery).  This has been proven to be as safe as the older “open” method but this is always an option if the laparoscopic procedure proves to be difficult or hazardous.

In laparoscopic cholecystectomy the operation is carried out through four 1” or smaller cuts (incisions).   The “open” method involves making a much larger cut, e.g. from umbilicus to rib cage in the midline.    Both operations require a general anaesthetic.  In key-hole surgery the patient stays in hospital for about 3 nights & in the “open” method for up to 5 nights.

Operation (cholecystectomy) can be carried out as an emergency in acute cholecystitis – within 36 hours – otherwise is delayed for about 6 to 8 weeks following an attack of cholecystitis to allow “tissues to settle down”.  During this time or if you have to wait for surgery for any other reason, it is absolutely essential to refrain as much as possible from eating fatty or oily foods as these make the gall bladder contract resulting in biliary colic & may re-kindle the infection.

After the gall bladder is removed you may eat normally – Bon Appetit !