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Gall stones (Cholelithiasis)- Treatment

This post is also available in: हिन्दी (Hindi)

How gall stones are treated?

The gall stones are predominantly treated by means of surgery or procedures.

Gall stones without symptoms

Typically patients with no symptoms doesn’t require surgery except for following cases:

• Gall bladder stone of size more than 3 cm.

• Calcified gall bladder wall (porcelain gall bladder)- risk of developing cancer

• Hemolytic anemia

• Morbidly obese who are considering weight reduction surgery.

However, some people prefer to undergo treatment due to their personal choice to avoid development of complications.

A person with gall stones should be aware of the complications it can cause and how they can present so the he can opt for treatment without any delay.

Gall stones presenting with symptoms

When the gall stones causes symptoms, they are typically treated with surgery where the gall bladder is removed. The gall bladder can be removed in two ways:

 

Surgery

Laparoscopic cholecystectomy: using thin special tubes fitted with camera and tools.

cholecystectomy-information

Open cholecystectomy: by cutting open the abdomen and removing the gall bladder

Risk of deferring surgery

Some people may prefer to wait and watch if need to undergo surgery. These people have been found to risk of following things

• Risk of recurrence: about 50% within 1 year of the first episode.

• Risk of complications: about 0.5% to 3% per year risk of developing complications such cholecystitis, cholangitis, pancreatitis etc.

 

Laparoscopic cholecystectomyOpen cholecystectomy
Surgical method• Done by using thin special tubes fitted with camera and tools which are inserted through small holes in the abdomen.• Done by cutting open the abdomen and removing the gall bladder.
Indications• Usually first surgical option for treatment GB stones presenting with symptoms (cholelithiasis)

• Done expect in certain specific conditions

• When laparoscopic surgery fails

ERCP to remove bile duct stone

• Morbid obesity

• Gangrenous cholecystitis

• Suspected bile duct injury

Pros• Early recovery

Lesser post-op problems pain, infection

• Better cosmetic results with no obvious scar mark on the skin

• Can be used for definitive treatment of stones in gall bladder or bile duct

• Reduces possibility of double surgeries in especially in complicated cases.

Cons• Restricted indication

• Some cases may eventually require open surgery- in about 6% to 35% of gall stones with acute cholecystitis

• Slower recovery

• More post op problems such pain, infection at the site of cut.

• Obvious scar mark formed on the skin.

Medicines

Pain killers: are the first treatment to be given to manage the symptoms of pain. Your doctor may give you either a NSAIDs or opioid analgesics. Depending upon what is best suitable for you

Usually NSAIDs are preferred as it has fewer adverse effects and provide faster pain relief.

Fasting may also help in decreasing some pain

Medicines for dissolution of stones:

• For dissolution of gallstone your doctor may prescribe oral bile salts such as chenodeoxycholic acid and ursodeoxycholic acid.

• These medicines are most effective in dissolution of noncalcified cholesterol stones. Also requires that gallstones are small (5 mm or smaller in diameter), gall bladder is functioning, and cystic duct is patent

• Indication: people with gall stones who refuse surgery

• People who have risks associated with surgery

• When the gall stone size is 5mm or smaller, gall bladder is functioning and drainage is patent.

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