Q: How common is Gallstones ?
A: It is fairly common problem across the world. Studies from Chandigarh showed the prevalence of disease to be as high as 21% in females.It is accepted world wide that northern India has one of the highest gallstone prevalence. Papers from G.B.pant hospital, Delhi and B.H.U. Varanasi have shown that not only Gallstones but GallBladder cancer is also common. Also it is worth mentioning that though exact cause and effect relationship has not been proved conclusively but approx. 70% of gallbladder cancers are associated with stones in Gallbladder.
Q: What are the symptoms ?
A: a) Biliary Colic – One of the common presentation is severe, spasmodic pain in right upper abdomen often with nausea and vomiting which is triggered by a fatty meals. Not all have this classical pain. Some patients present with indigestion, abdominal fullness and heaviness in abdomen.
b) Cholecystitis – Another common manifestation is persistent right upper abdomen pain, which is often associated with fever. This may require hospital admission and treatment with antibiotics and I/V fluids.
C) Gallstone pancreatitis – This remains one of the most dreaded complications of gall stones which could be life threatening if not managed properly.
d) Jaundice and Cholangitis – Some times gallstones can slip from the Gallbladder and block the passage of bile into Duodenum. This results in to spillage of Bile into blood stream resulting into jaundice. Also when the passage of bile i.e. bile ducts get infected then they cause Cholangitis. Often these condition are misdiagnosed and treated as viral hepatitis and patients are referred to surgical gastroenetrologist at a later date requiring I.C.U. admission and prolonged hospital stay.
e) Asymptomatic – Some patients with gallstones do not have any symptoms or problems. These may have been identified during routine health check up or on U.S.G. abdomen done for some other reasons. These patients may not require any treatment. The chances of these patients becoming symptomatic in future varies considerably. By and large studies support that 1-4% of patients with asymptomatic gallstones will develop biliary symptoms per year.
Calcified or porcelein gallbladder is a condition which requires surgery even when patients may not have any symptoms as they have been associated with high risk for malignancy. Similarly in sickle cell disease Cholecystectomy in controlled condition for asymptomatic gallstones is justified.
Q: How it is Diagnosed ?
A: With wide availability of ultrasound these conditions are detected very easily and at an early stages. Sonography is cheap, patient friendly and can be done even during pregnancy. Computerized Tomography (C.T.scan) is required when there is a possibility of other disease or complication is expected.
Q: What is the treatment ?
A: Once it has been proved that symptoms are due to gallstones, only treatment is Surgery. Pain killers can only buy time. Medicines to dissolve gallstones are not of proven efficacy.
Q: What is the Nature of Surgery ?
A: Surgery in gallstones involves the removal of Gallbladder along with stones inside. As entire Gallbladder is removed hence there is no chance of recurrence of stones in future. This is done now-a-days by Laproscopy (Key-Hole). This does not require large cut on the body as it was done in the past. However in approx. 1.8-7.8% of patients open surgery may be needed if there is any abnormal anatomy or conditions like Mirizzi ‘s syndrome.
Q: Who does the Surgery ?
A: Laparoscopic Cholecystectomy has become the gold standard but it also has increased chances of complications e.g. bile duct injury. Therefore it is essential that patient should seek advice from a trained Surgical gastroenterologist of his city. Surgical gastroenterologist with experience in Hepato – Biliary surgery can foresee and tackle any unexpected problem .The best way to treat problems associated with surgery of Gall Bladder is to prevent them.
Q: Do I need to change the diet after surgery ?
A: It’s a common misconception that after surgery one can not have normal diet. However after surgery most of the patients do not require to observe any dietary precautions .
Q: When can I resume normal activity ?
A: With the advent of Laparoscopic surgery the surgery has become very patient friendly. The patient is usually discharged on next day. He/she can resume his normal activity from next day itself. With modern suture material and dressings patient can have bath from next day itself. Subsequently patient can have normal active life.
Q: What is the follow up ?
A: After surgery it is advisable to meet the doctor after 1 weak with biopsy report. Assuming everything is alright nothing further is needed. Stitches are dissolvable and need not be removed.
Q: Is there any way to prevent the Gallstone formation ?
A: At present a clear cut answer eludes us. However a diet which is low in saturated fatty acids and cholesterol, high in fibers with vitamin C, avoiding obesity and regular exercise can be recommended to prevent the formation of gallstones.