Your treatment plan will depend on how the symptoms are affecting your daily life.
In cases of gallstones without symptoms, a policy of ‘active monitoring’ is often recommended. This means you will receive no immediate treatment, but you should let your GP know if you notice any symptoms.
As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.
You may need treatment if you have a condition that increases your risk of getting complications. These conditions include:
Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.
If you have episodes of biliary colic. Treatment will depend on how the symptoms are affecting your daily activities. If your symptoms are mild and infrequent, you may be prescribed painkillers to control further episodes.
Surgery to remove your gallbladder (laparoscopic cholecystectomy) will usually be recommended if your symptoms are more severe and occur frequently, and lead to a reduction in your quality of life.
Laparoscopic cholecystectomy
A cholecystectomy is surgery to remove your gallbladder, and laparoscopic is a type of keyhole surgery.
Three or four small cuts (each about 1cm or less) are made in your abdomen. One cut will be by the belly button and the others will be on the right side of your abdomen.
Your abdomen is inflated using carbon dioxide gas. This is harmless and makes it easier for surgeon to see your organs.
A laparoscope (a long thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen. This allows your surgeon to view the operation on a video monitor.
Using special surgical instruments, your surgeon will then remove your gallbladder.
Sometimes, if there is a risk of gallstones in the bile duct, an X-ray of the bile duct (operative cholangiogram) is also taken during the operation. If gallstones are found, they can sometimes be removed during keyhole surgery.
If the operation cannot be done this way or an unexpected complication occurs, it may have to be converted to open cholecystectomy (see below).
Bile duct stones can also be removed before or after your operation with a special endoscopy called an ERCP, or endoscopic retrograde cholangiopancreatolography.
After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings.
The operation takes 60 to 90 minutes and is usually carried out as a day case, so you can go home that day.
Single-incision laparoscopic cholecystectomy
Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder.
Only one small cut is made, which has the cosmetic advantage of leaving a barely visible scar.
However single-incision laparoscopic cholecystectomies haven’t been carried out as often as traditional laparoscopic cholecystectomies, so it is still very much an evolving field of medicine.
Access to this type of surgery is also limited because it needs an experienced surgeon with specialist training.
Open cholecystectomy
In some circumstances, a laparoscopic cholecystectomy may not be recommended. This may be due to technical reasons, safety concerns or if there is a stone in the bile duct that cannot be removed another way. A laparoscopic cholecystectomy may not be recommended if you:
- are in the third trimester (the last three months) of pregnancy
- are morbidly obese – extremely overweight with a body mass index of 40 or above
- have cirrhosis (scarring of the liver)
- have a condition that affects your blood’s ability to clot (thicken), such as haemophilia
In these circumstances, an open cholecystectomy may be recommended. During this procedure, a 10-15 cm (4-6 inch) incision is made in your abdomen underneath the ribs. This will result in a scarring.
Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time. Most people take about six weeks to recover from the effects of an open cholecystectomy.
Endoscopic retrograde cholangiopancreatolography (ERCP)
Endoscopic retrograde cholangiopancreatolography (ERCP) is a procedure that aims to remove bile duct stones. In some patients this is the only treatment required. However, the gallbladder and stones in the gallbladder remain.
An ERCP is usually carried out under sedation, which means that you will be awake throughout the procedure but will not experience any pain.
ERCP is similar to a diagnostic cholangiography, except that an electrically heated wire is passed through the endoscope and is used to widen the opening to your bile duct. The bile duct stones are then removed or left to pass into your intestine. Sometimes a small narrow tube called a stent is placed in the bile duct to help the bile and stones pass.
Alternative treatments
A number of alternative treatments have been tried but they are not very successful, have problems of their own and gallstones can reoccur very quickly once treatment is stopped.
Tablets to dissolve the gallstones (ursodeoxycholic acid)
A few patients' small non-calcified gallstones made of cholesterol in a normally functioning gallbladder can be dissolved by taking a medication called ursodeoxycholic acid for up to two years. To make treatment more effective, you may be advised to eat a low-cholesterol diet.
Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin. The use of ursodeoxycholic acid is not usually recommended for pregnant or breastfeeding women.
Sexually active women should use either a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.
Once the treatment is stopped the gallstones usually reoccur.
Ursodeoxycholic acid can also be prescribed as a precaution against gallstones if it is thought that you are at risk of developing them. For example, you may be prescribed ursodeoxycholic acid if you have recently had weight loss surgery.
Lithotripsy
Lithotripsy is a method of concentrating ultrasonic shock waves on to the gallstones to break them up into tiny pieces. Once the gallstones have been broken up, they can pass out of your body in your stools (poo). Unfortunately, in some patients the gallstones remain and grow, and in others the debris causes acute pancreatitis or jaundice.
It is rarely used when other treatments are possible as there can be up to a 50% chance of symptoms returning within five years of treatment.
The healthcare professional carrying out the lithotripsy procedure will first use an ultrasound scan to determine the location of the gallstones.
They will press a sensor against your abdomen, next to the gallstones, which will then deliver the ultrasonic waves on to the gallstones.
