Gallstone disease is one of the common surgical diseases, and its incidence has been on the rise in recent years, with a prevalence of 7.5% in adults in Shanghai in 2010. In addition to gallbladder stones, stones can also occur in the intra- and extra-hepatic bile ducts, all of which fall under the category of cholelithiasis. When diagnosed with cholelithiasis, patients are often most concerned with these questions: Will the gallstones heal with medication? Do I need surgery? Will it require traditional open surgery or a “hole in the wall”? Does removal of the gallbladder affect the body? What are the consequences of not having surgery?
Before answering these questions, let’s simulate the relationship between the liver, bile ducts and gallbladder. The liver is like a waterworks, the water it produces (bile) is transferred through a complex plumbing system (intrahepatic bile ducts) to the reservoir (gallbladder) and when needed (eating), the reservoir drains water (bile) through the drain (extrahepatic bile ducts) into the user’s home (intestines). When the water plant or pipeline problems, water quality changes, it is easy to appear scale (bile sludge), if not managed, the scale further accumulation (the formation of gallstones la) will block the pipeline.
Of course, the formation of gallstones is very complex, the current medical consensus risk factors for gallstone disease include: obesity, especially centripetal obesity, hypertension, diabetes, hyperlipidemia and fatty liver; with the increase in age, the incidence of gallstone disease will also rise; poor dietary habits and women’s pregnancy is also a high risk factor for gallstone disease.
Understanding the above relationships, let’s talk about the concerns of gallstone patients.
Q: Will gallstone disease get better with medication?
When bile sludge is initially formed, we can indeed achieve to stop or alleviate further gallstone formation with medications such as cholagogic granules or ursodeoxycholic acid. Clinically, there are usually cholesterol crystals or bile mucus-like changes in the gallbladder as suggested by ultrasound during a physical examination, usually without symptoms.
And when gallstones are formed, especially for bile pigment stones, these so-called cholestatic litholytic drugs often do not play a good therapeutic role.
Q: Do I need surgery for gallstone disease?
In principle, all symptomatic gallbladder stones require surgery, while bile duct stones often require surgery due to their tendency to cause obstruction of the bile duct and affect liver function. Typical symptoms of stony cholecystitis are discomfort and pain in the upper and middle abdomen after meals, which can be easily confused with “stomach problems”.
For so-called “quiescent” gallbladder stones without symptoms, if they are single stones, larger than 5 mm directly, and the cystic duct is not dilated, they can be followed up periodically. In elderly patients, women with underlying diseases or those who are preparing for childbirth, surgical treatment should be considered even if asymptomatic, because the risk of emergency surgery is higher in the first two cases when conservative treatment for acute attacks is ineffective, while in the latter case, if acute cholecystitis occurs during pregnancy, clinical treatment is greatly constrained due to fetal considerations. In addition, atrophic gallbladder with or without stones is an absolute indication for surgery.
Q: What about traditional open surgery or minimally invasive?
One is to pull out by hand in a deep small incision, and the other is a fine operation with a high-definition magnified view. Undoubtedly, laparoscopic cholecystectomy has been the international gold standard surgery for decades. Of course, when laparoscopic surgery is difficult, open traditional surgery as a complementary means is also needed in some special cases, and at the current level of medical care, the chance of laparoscopic conversion to open surgery is less than 5%, so trust your doctor’s words, not the old king’s next door.
For extrahepatic bile duct stones, which are often called common bile duct stones, we can use a method similar to gastroscopy (transendoscopic retrograde cholangiopancreatography, ERCP) to remove the stones. Of course, the success rate of ERCP is not 100%, we can also use laparoscopic choledochal exploration to achieve the purpose of stone extraction, which is also minimally invasive!
Q: Is there any harm to my body when I have my gallbladder removed?
Here, we can review what we have learned earlier, the gallbladder is like a reservoir that temporarily stores bile and releases it into the intestine when needed. Of course, the most important physiological function of the gallbladder is to concentrate bile, which can fully emulsify fat and protein, which is more conducive to the absorption of the small intestine.
If we don’t have a gallbladder, the most obvious effect is steatorrhea after eating, which means that we tend to have more frequent bowel movements. It is important to know that the human body is extremely adaptable, and usually the above situation will improve significantly in the six months after surgery, when the expansion of the extrahepatic bile ducts compensates to play a part in the function of the gallbladder. It is important to know that far more people in this world have their gallbladder removed every day because of gallbladder stones than you can imagine, so there is no need to worry about it.
Q: What will happen to gallstone without surgery?
Imagine the consequences of a hard stone rubbing against the gallbladder as it contracts every day. The complications of cholelithiasis generally include acute and chronic cholecystitis, gallbladder perforation, acute cholangitis, gallstone cirrhosis, acute biliary pancreatitis, liver abscess, etc. The most terrible thing is that it is closely related to the occurrence of gallbladder cancer and bile duct cancer. According to statistics, gallbladder cancer combined with stones is 13.7 times more common than patients without stones, while 30% of patients with bile duct cancer are accompanied by bile duct stones.
Of course, gallstone induced tumors of the biliary system often take 15 to 20 years or more, so gallstone disease does not represent cancer.
Although cholelithiasis is a highly prevalent disease, but, as long as rational medication and timely surgery are used, cholelithiasis is not terrible, and I believe that we can face cholelithiasis correctly, dear cholelithiasis patients.