Gallstones & Cholecystectomy

How do I know I have gallstones?

The type of pain caused by gallstones is called biliary pain.  Its characteristics are as follows:

  • Nature: Steady (not colicky or windy pain)
  • Intensity: Severe enough to inferfere with your activity
  • Location: Upper abdominal pain (may be in the chest and back/shoulder blade)
  • Duration: Not less than 15 minutes, usually 1 to 5 hours
  • Onset:  Rapid
  • Relief: Not relieved by household remedies, position change or passage of   wind
  • Frequency:Usually episodic and infrequent rather than continuous
  • Timing: May occur after food.  Often wakes people at night (usually in the early hours of the morning).
  • Belching, bloating and fatty foods intolerance occur equally often in those with and without gall stones.

What will happen if I don’t have surgery?

Asymptomatic gall stones (If your gallstones are not causing you pain):

After gallstones are detected serious symptoms and complications will probably develop in 2 in every 100 people per year.  This gets less common after ten years.

Biliary pain is the first symptom to develop in about 90% of people with previously asymptomatic gall stones.  After 20 years, two thirds of patients with asymptomatic gallstones will have had no biliary pain or complications.

The lifetime risk of death with a wait and see approach is 0.8% to 2%.  The risk may increase the older you are when your gall stones are detected.

Symptomatic gallstones (If your gallstones are causing you pain):

About 30% of patients who have an episode of biliary pain will not have further episodes of pain during the next ten years.

About 1-2 patients in every 100 develop complications of gallstones per year.  After 20 years about half the patients with symptomatic gallstones will not have had a biliary complication.

The lifetime risk of death with a wait and see approach is 2% to 6%. The risk increases the older you are and when your gallstones are first detected.

What will happen if I have surgery?

Types of Surgery:

There are two types of surgery; open cholecystectomy (through an abdominal incision) and laparoscopic cholecystectomy(keyhole surgery).  Most people have laparoscopic surgery, although open operation may rarely be more appropriate for you.  The average stay in hospital for open cholecystectomy is 5-7 days and 1-2 days for laparoscopic surgery.  Laparoscopic surgery has less post-operative pain, earlier return to activities and better cosmetic appearance.

Benefits of Surgery

94-97 of very 100 patients will be cured of their pain after laparoscopic cholecystectomy.  The complications of gallstones will be prevented.

Risks of Surgery

Studies of laparoscopic procedures have found the following types of problems:

  • Complications: 3-8 people in every 100
  • Bile duct injuries: 1  in every 1000 people
  • Conversion to Open Procedure:  2-4 people in every 100
  • Deaths: 1 in every 1500-3000 people

Open operations may have a slightly lower rate of bile duct injuries and slightly higher rates of overall complications and deaths.

Indications for Cholecystectomy

  • Any patient with a complication of gallstone disease.
  • Any patient with uncomplicated symptomatic gall stone disease who has had the natural history of symptomatic gallstones explained to them, and makes an informed choice to have surgery.
  • Asymptomatic gallstone patients with a calcified gallbladder or a gall bladder polyp greater than one centimetre in diameter
  • Selected asymptomatic diabetic patients with gallstones