Surgical treatments

The removal of your gallbladder is the most usual treatment for gallstones which are causing frequent and severe symptoms. Your gallbladder is not essential for life and most people notice little difference without it. It actually stops working properly when stones form, so your body has already adjusted to its loss.

Laparoscopic cholecystectomy¹⁹ 
Nowadays the gallbladder is usually removed by a keyhole surgery procedure. A laparoscopic cholecystectomy is performed under a general anaesthetic using a fibre-optic tube with a tiny camera and a light on the end, called a laparoscope. A small incision in your tummy will be made and your abdomen inflated with carbon dioxide gas. Inflating your abdomen gives the surgeon a better view of your organs and more room in which to work. Instruments are then inserted into the abdominal cavity through three small incisions and controlled very precisely by the doctor, who is able to view your organs via a TV screen. The gallbladder is removed through a small cut in your navel.

Afterwards you will have a stitch or two and may have some pain, but oral painkillers are usually enough to dull this. Most people are allowed home the following day. You should have someone drive you as it is unlikely you will be fit to drive for 10 – 14 days.

When discharged, your surgeon will recommend that you take it easy for a few days. You may feel some soreness or bruising internally for a while. Generally, people are back to normal activities within two-three weeks; although this can depend on the individual and you should allow yourself time to recover.

If you develop severe worsening pain, jaundice or a high temperature, you should seek urgent advice from your GP or the A&E department.

Open cholecystectomy
Sometimes it is not possible to remove the gallbladder by keyhole surgery and a more extensive operation or a conversion to open surgery is required, this may be due to the following:¹

• you are in the third trimester (the last three months) of your pregnancy
• you are obese
• your gallbladder is severely inflamed and it is deemed unsafe to remove it laparoscopically
• you have an unusual gallbladder or bile duct anatomy that makes continuing with a laparoscopic procedure potentially dangerous.  

The procedure is performed under a general anaesthetic; the surgeon makes a large incision in your abdomen and removes your gallbladder. After the procedure you will have stitches and may be in some pain. This can usually be controlled with oral painkillers. You may need to spend four to five days in hospital to recover, and take four to six weeks to convalesce.

The gallbladder is usually sent for examination; your surgeon will review the report and arrange to see you accordingly.

Aftercare
For a short while after your surgery you may experience some nausea due to the anaesthetic or painkillers administered to you. You may also feel a little bloated, or have pain in your abdomen or shoulders due to the gas used to inflate your abdomen during surgery; this should usually pass within 48 hours.

On discharge you will normally be given oral painkillers for few days to control any pain and discomfort. Occasionally some people are prescribed oral antibiotics to take for a few days. 

Your surgeon may arrange a follow-up outpatient’s appointment for four to six weeks time. 

After the removal of your gallbladder, bile is no longer stored and will dribble continuously from the liver, through your common bile duct, into your intestine, rather than only being released after meals. It's rare that you will have any change in digestive ability after having your gallbladder removed and most people notice little difference without it¹.

Some people experience an increase in wind (gas passed from your rectum), bloating or increased bowel movements after meals for several weeks following the procedure. In most cases these changes are short term and will get better.

About one out of every ten people who have their gallbladder removed will experience diarrhoea; this is because the continuous release of bile salts irritates their digestive system²¹. This usually improves over time, but if it does not, your doctor may recommend anti-diarrhoea medicines to slow down your bowel movements. Dietary changes may also help (see ‘Looking after yourself’ section).

Non surgical treatments  

If you are unable to have your gallbladder removed, or do not wish to, the following may help to manage your symptoms²²:

• pain control
• life style changes, such as weight loss, increased exercise and decreased calorie intake
• a very strict low fat diet, to help reduce the frequency and severity of symptoms. 

Alternative treatments to remove stones are listed below. However, these methods are only effective in a small number of people with gallstones (around one in 10)¹. Methods such as dissolving gallstones with drugs or using shockwave therapy are now rarely used, as they are beneficial in few patients and reccurrence of stones is common²². If alternative treatments fail, you may still require surgery.

ERCP (endoscopic retrograde cholangiopancreatography)
Sometimes stones which have passed into the bile duct can be removed during an ERCP examination (see ‘Diagnosis’ section) under sedation. This can be done using a number of techniques.

The first is an endoscopic sphincterotomy, where an incision in the muscle between the common bile duct and the pancreatic duct enables the removal of stones or allows them to pass into your intestine.

Another method which may be used is ‘trawling’ of the common bile duct with a ‘basket’ or ‘balloon’ to remove stones.

Widening the opening to the bile duct with an electrically heated wire (diathermy), which you won't feel, may be needed to carry out these procedures. Sometimes a short plastic tube called a stent is inserted into the bile duct to help bile drain out. The stent may remain in place permanently or be removed at a later date.

An ERCP is often performed in addition to having your gallbladder removed in circumstances where stones have passed out of your gallbladder¹⁹.

Ursodeoxycholic acid (URSO or UDCA)⁵ 
URSO is a naturally occurring bile acid which can be prescribed to treat cholesterol stones in a limited number of circumstances^{1, 22.}. It works by slowly dissolving the cholesterol stones, but can have side effects such as nausea, vomiting, diarrhoea and itchy skin¹. It is taken orally in tablet form and a course of treatment can last up to two years. Long term monitoring after finishing the course may be needed as gallstones recur in up to one in four people (25%) within one year²³.

Extracorporeal shockwave lithotripsy (ESWL)
ESWL treatment has been used in the past to treat cholesterol gallstones, where surgery was not an option and ERCP had failed^19,24.

ESWL treatment uses high-energy sound waves to break gallstones into tiny fragments³. A lithotripter sensor (a probe-like instrument) will focus the shock waves on each stone.

After the procedure, medication is needed to help dissolve any fragments of stone and an ERCP may also be required to remove the remaining fragments left in the bile duct. Some pain and discomfort may be felt. A few people may experience other complications such as:

• infection
• blockages in the bile duct due to fragmented stones
• some bruising or blistering of the skin.