Cholelithiasis or gallstones are solid deposits of digestive fluid that can form in the gallbladder. The gallbladder is a small organ located just below the liver and is responsible for secreting bile into the small intestine.
In patients with asymptomatic gallstones, the chance of developing symptoms or complications is 1% to 2% per year. Asymptomatic gallstones found in a normal gallbladder and biliary tree do not need treatment unless they develop symptoms.
However, approximately 20% of these asymptomatic gallstones will develop symptoms after 15 years of follow-up. These stones may cause complications such as cholecystitis, cholangitis, cholelithiasis, acute pancreatitis, and rarely cholangiocarcinoma.
What are the main causes of gallstones?
There are three main pathways to gallstone formation:
Cholesterol oversaturation: Normally, bile can dissolve the amount of cholesterol secreted by the liver. But if the liver produces more cholesterol than the bile can dissolve, the excess cholesterol can precipitate as crystals. The crystals get trapped in the gallbladder mucus, producing sludge. Over time, the crystals can grow to form stones and block the ducts that eventually cause gallstone disease.
Excess bilirubin: Bilirubin, a yellow pigment that comes from the breakdown of red blood cells, is secreted into bile by liver cells. Some blood conditions cause the liver to produce too much bilirubin through the process of breaking down hemoglobin. This excess bilirubin can also cause gallstones to form.
Biliary dyskinesia or decreased contractility: If the gallbladder does not empty effectively, bile can pool and form stones.
Depending on the etiology, gallstones have a different composition. The three most common types are:
- cholesterol gallstones
- black pigment gallstones and
- brown pigment gallstones
Ninety percent of gallstones are cholesterol stones.
What are the main risk factors for developing gallstones?
The factors that may affect the occurrence of gallstones are the following:
- female sex
- total parenteral nutrition
- rapid weight loss / crash diets
- certain medicines that contain estrogen
- blood disorders such as anemia
What are the symptoms of gallstones?
Symptoms usually do not appear in the case of gallstones, but if they do appear, they usually include:
- Abdominal and back pain. Pain is generally rare, but particularly acute.
- Increased abdominal pain after eating a fatty meal.
- Fever, if the gallbladder or bile duct becomes infected.
The severe symptoms and complications of gallstones occur when stones block the cystic duct, the bile ducts, or both. Temporary obstruction of the cystic duct leads to pain in the bile ducts, but it is usually short-lived.
More persistent obstruction of the cystic duct can lead to acute cholecystitis. Sometimes a gallstone can pass through the cystic duct, get stuck, affect the common bile duct, and cause obstruction and jaundice. Occasionally, large gallstones puncture the gallbladder wall and create a fistula between the gallbladder and the small or large intestine, causing a bowel obstruction or ileus.
What is the treatment for gallstones?
Uncomplicated cholelithiasis can be treated acutely with oral or parenteral analgesia once the diagnosis is established and alternative diagnoses are excluded. Patients should also be given nutritional advice to reduce the chance of recurrent episodes and referred to a general surgeon for elective laparoscopic cholecystectomy.
Today, laparoscopic cholecystectomy is the standard of care because of its minimal invasiveness. It is surgery to remove the gallbladder. The specialized surgeon makes a few small incisions on the right side of the abdomen and inserts a laparoscope, which he guides and then, based on this, removes the degenerated part. Laparoscopic cholecystectomy is less invasive than an open cholecystectomy. It is an extremely safe method of dealing with gallstones, while at the same time it has an immediate recovery and return to everyday life.
In the event of symptoms suggestive of cholelithiasis or the need for laparoscopic cholecystectomy, the selection of a specialized and fully qualified general surgeon is imperative. Dr. Pericles Chrysocheris is the most suitable for performing laparoscopic cholecystectomy. He has trained in laparoscopic surgery at Boston University Medical Center, Massachusetts General Hospital, Department of Surgery and Harvard Medical School.