What are Gallstones?
The gallbladder is responsible for storing bile produced by the liver. Bile is composed of bile acids and salts, cholesterol, lecithin, and other constituents, and in the event this composition becomes unbalanced, hardened deposits may begin to form in the gallbladder, which may accumulate to eventually become gallstones. In addition to stones forming in the gallbladder, stones can also develop in the hepatic bile ducts. Medical estimates suggest that 1 in 10 people in Hong Kong has gallstone issues, making it a common digestive system disease. However, the exact causes of gallstone formation are still not fully understood.
Symptoms
A common symptom of gallstones is pain and bloating in the upper abdomen which intensifies after meals, especially if greasy foods have been consumed. The discomfort is often more severe on the right side, and may even extend towards the back, causing nausea and vomiting. If the gallbladder is infected or inflamed, the patient will experience pain in the upper right portion of the abdomen. Gallstones that move into the bile duct and become lodged there may cause life-threatening acute Cholangitis, jaundice, and even severe, inflammation of the pancreas.
Cause
The medical community has not fully understood the causes of gallstone formation. It can be related to family. If a family member has had gallstones, other family members are at a higher risk of being affected. Women, obese individuals, those with hemolytic anemia, and individuals who have undergone gastric surgery are also more prone to gallstone issues.
Certain chronic conditions, such as cardiac disease, diabetes, cirrhosis, and hepatitis, and other chronic medical diseases increase the risk of complications from gallstones compared to the general population. Particularly for diabetic patients, who often have reduced sensory perception, gallstone problems may be detected later. Once acute cholecystitis occurs, there is a greater likelihood of complications such as kidney failure or failure of other organs, leading to a higher mortality rate.
Diagnosed
Clinically, ultrasound can be used to diagnose the presence of gallstones, including very small stones like sand. MRI can help visualize the patient's bile duct structure. Whether to perform a cholecystectomy depends on the patient's symptoms and any complications, such as cholecystitis or impacts on liver function. The surgery may involve the removal of the entire gallbladder or using an endoscope to remove stones from the common bile duct.
Treatment
Many gallstone patients resist gallbladder removal, mistakenly believing it will affect their digestive function. The gallbladder is merely a storage organ for bile, which is secreted by the liver. After removal, bile can still flow directly into the duodenum to aid digestion, resulting in minimal impact on digestive function. Surgical removal of the gallbladder is the ideal treatment option. After the surgery the patient will be freed of gallstones related disease in the future. Readmission rate in the future is almost zero because the causative factor is removed. Treatment options include:
- Medication
Patients may take medications to dissolve gallstones, but the effectiveness of this method depends on the composition of the stones. It only works on pure cholesterol stones. In reality, the majority of the stones are of the mixed type and cannot be dissolved by this medication. This treatment method is rarely used because once treatment stops, gallstones quickly reform. - Minimally Invasive Cholecystectomy
By making 3-4 small incisions of about 0.5 to 1 cm in the patient’s abdomen, the doctor inserts an endoscope and surgical instruments to remove the gallbladder. The advantages of this type of surgery include smaller wounds and less blood loss, which help minimize the pain and risk of infection for patients. Patients are generally discharged from the hospital either the same day or the next day after the procedure. - Minimally Invasive Single Port Cholecystectomy
The surgery is performed via an incision in the navel of one single wound about 2.5-3.5 cm in length, through which an endoscope and surgical instruments are inserted. It leaves minimal scarring that is nearly undetectable because the wound is hidden inside the umbilicus after recovery. Most of the patients are able to resume eating the same day, the day of discharge is similar to the multiport minimal invasive surgery. As this single wound is bigger, the level of pain may be sightly higher and risk of wound related complications also be slightly higher. The main advantages in this technique is the very early cosmetic result. - Cholecystectomy
During the surgery, an incision of approximately 6 to more than 10 cm is made in the upper right abdomen. However, because it involves muscle and fascia, the recovery period after the surgery is relatively longer compared to laparoscopic surgery. Also as the wound size and level of trauma increases, the complications rate also increased compare to keyholes surgery.
