Treatment of Gall Stones

Most gallstones are silent.

If silent gallstones are discovered in an individual at age 65 (or older), the chance of developing symptoms from the gallstones is only 20 per cent (or less). Such cases do not require any treatment.

In young individuals, treatment should be considered even for silent gallstones because of young individuals’ chances of developing symptoms from the gallstones over a lifetime will be higher. Once symptoms begin, treatment is a must since recurrences are likely and complications may also occur.

•Surgery to remove the gall bladder – cholecystectomy.

Cholecystectomy (removal of the gall bladder surgically) is the standard treatment for gallstones in the gall bladder. People can live normally without a gall bladder and do not need a change in diet or a special diet. Digestion is not affected.

When the gall bladder is removed, the liver continues to make bile. Instead of being stored  in the gall bladder, however, the bile flows directly into the small intestine. Problems following removal of the gall bladder are few. Chronic diarrhoea occurs in approximately 10 per cent of patients.

•Laparoscopic surgery.

It is also called ‘minimally invasive’ because the incisions are very small. Patients have to stay in the hospital for one or two days only They can start eating a normal diet a day after surgerv and  can resume normal daily activities 3 to 5 days after surgery. Scars of laparoscopic cholecystectomy are very small and barely visible.

•Traditional ‘open’ surgery.

The gall bladder is removed through a 5-inch to 8-inch incision in the abdomen just below the ribs. Open gall bladder surgery is used mainly on patients who have gall bladder infections, internal scar tissue from previous abdominal operations, or other problems that make laparoscopic surgery unsuitable.

With open surgery, patients have to stay in the hospital for 5 to 7 days and often have to spend several weeks at rest before resuming normal activities.

If a gallstone is stuck in the hepatic or common bile ducts removal of the gall bladder alone would not cure the disease. Rather, it would leave the ducts blocked by the stone, and symptoms would continue. Therefore in these cases, ERCP is used to remove the gallstones from the duct and than the gall bladder is removed.

• Oral dissolution therapy. It is possible to dissolve some cholesterol gallstones with oral medications. The medication is a naturally- occurring bile acid called ursodeoxycholic acid Ursodiol.

It reduces the amount of cholesterol secreted in the bile. The main side effect of drug therapy is mild diarrhoea. Ursodiol is only effective for cholesterol gallstones and not pigment gallstones. It works only for small gallstones, less than 1-1.5 cm in diameter and it also takes 1 -2 years for the gallstones to dissolve.

Gallstones may form again following the cessation of treatment. Due to these limitations, ursodiol is generally used only in individuals with smaller gallstones that are likely to have very high cholesterol content and who are at high risk for surgery because of ill health.

• Extracorporeal shock-wave lithotripsy. Extracorporeal shock-wave lithotripsy (ESWL) is a method for treating gallstones, particularly for stones that are lodged in bile ducts. ESWL generators produces Shockwaves that are focused on the gallstone. The shock waves break the gallstone. The resulting pieces of gallstone either drain into the intestine on their own or are extracted endoscopicallv.

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