What are gallstones?
Gallstones develop when
cholesterol and other substances in the
bile form crystals that become hard stones in the
gallbladder. The stones may form because of too much cholesterol in the bile or
because the gallbladder does not empty properly.
block the common bile duct.
Most gallstones do not cause symptoms.
In people who do have symptoms, the most common complaint is pain of varying
intensity in the
upper right area (quadrant) of the abdomen. Nausea and vomiting also may
develop along with the pain. If gallstones block the common bile duct, you may
jaundice, dark urine, and light-colored stools.
How are gallstones treated?
Gallstones that cause
symptoms are treated mainly with surgery to remove the gallbladder. Symptoms
usually do not return after the gallbladder has been removed.
types of surgery may be done, one using a large incision (open cholecystectomy) and the other involving several small incisions (laparoscopic cholecystectomy). Laparoscopic surgery is
generally preferred because it causes less pain after the operation and people
can return to work and other activities more quickly than with open
rare cases, doctors may try nonsurgical methods to remove gallstones.
Bile acids are sometimes used to dissolve gallstones.
They may be used alone or after
lithotripsy, which breaks up small, noncalcified
gallstones with shock waves that are focused by ultrasound.
some people with stones in the common bile duct, a special type of
endoscopic retrograde cholangiopancreatogram (ERCP)
called endoscopic sphincterotomy may be used to remove gallstones that block
the common bile duct. The doctor places an
endoscope down the throat to the small intestine. The
doctor then uses another procedure to widen the opening between the common bile
duct and the small intestine and takes the stones out using a small basket.
After ERCP, surgery to remove the gallbladder is often the next step.
However, endoscopic sphincterotomy may not prevent the need for
gallbladder removal. One study found that symptoms returned within 2 years in
47% of people who had only sphincterotomy, compared with 2% who had immediate
gallbladder removal. Of those people in the study who had recurrent symptoms,
81% eventually needed gallbladder removal (cholecystectomy).3
Overall, gallstones return within 5 years after
nonsurgical treatment in 30% to 50% of people.1
What are the risks of not having the gallbladder removed?
There is little risk in not having surgery if you have
only one bout of mild symptoms. However, if you have more than one episode of
pain, you are likely to have more symptoms in the future.
risks of not treating gallstones may include:
- Unpredictable bouts of gallstone pain
- Episodes of inflammation or infection of the
gallbladder, bile ducts, or pancreas.
Jaundice and other symptoms caused by blockage of the
common bile duct.
- An abnormal connection (fistula) between the
gallbladder and the bowel. This is rare.
If you need more information, see the topic