Your gallbladder is the part of your liver that is responsible for making bile. Bile is needed to digest food in the intestines. Gallstones form when bile is thickened and gallbladder movement slows down. Gallstones form in the gallbladder. We call it cole lithiasis.
What happens if you don’t have your gallstones removed?
The following problems may occur if the surgeon does not remove the gallstone that needs to be removed in time:
- Acute inflammation of the gallbladder or acute cholecystitis
- Acute inflammation of the pancreas or acute pancreatitis
- And inflammation of the bile ducts of the liver or cholangitis
- If you have gallstones that have not caused you any particular symptoms, they do not need to be removed
Gallstones or lithiasis
Gallstone formation occurs when too much bile is made (for example, in obese people) or in women due to the presence of estrogen and high cholesterol.
Also, if the movement of the gallbladder, which causes the bile to be expelled, slows down (during pregnancy due to the hormone progesterone), the bile fluid that has become immobile will gradually increase in concentration and harden like a stone (cole lithiasis)
What is a cholecystitis?
Normally, bile must leave the gallbladder and pass through special ducts to the common bile duct, or CBD, and then drain into the small intestine. Increased concentration and decreased motility to excrete bile, as well as gallstones themselves, can block the outlet If the gallbladder becomes clogged, this blockage will be accompanied by inflammation of the gallbladder wall called cholecystitis.
Symptoms of cholecystitis
If your gallstones suddenly block the exit of the gallbladder, you will have acute cholecystitis with very severe and sudden pain spreading to the back and right shoulder:
- Abdominal pain
They will occur with acute cholecystitis
What is biliary colitis?
You may have pain in your upper abdomen and right abdomen for years, especially after eating a fatty meal, and spread to your back and right arm, which can take hours. You may also have nausea. This condition, which improves on its own, is called biliary colitis.
Cholangitis or inflammation of the bile ducts
A person may develop chronic cholecystitis for years but not enter the acute phase, which is accompanied by fever, jaundice, vomiting, and severe abdominal pain.
If the gallstone comes out of the gallbladder but gets stuck in the bile duct, it causes obstruction of the bile duct, and this is where the bile duct wall and the gallbladder behind the obstruction become inflamed. This condition is called cholangitis or inflammation of the bile ducts
What is acute pancreatitis?
Sometimes gallstones pass through the bile ducts of the liver but get stuck in the area that joins the pancreatic duct. Trapping of gallstones at the site of the vater ampulla causes both bile and pancreatic enzymes to accumulate behind the blockage site.
(Vater ampoulla = the place where bile from the liver and pancreatic juice, which are full of enzymes needed to digest food, are emptied together into the beginning of the small intestine)
If pancreatic enzymes move to the pancreatic tissue, they can cause the pancreatic tissue to digest itself, causing inflammation and damage, called acute pancreatitis.
Should every gallstone be removed?
Surgeons answer no to this question.
In many cases, cole lithiasis or gallstones are asymptomatic. In these asymptomatic cases, surgery will not be necessary.
What is a cholecystectomy?
Cholecystectomy means removal of the gallbladder
Cholecystectomy will be the treatment of choice for acute cholecystitis and symptomatic gallstones.
Analgesics are used to relieve the pain of acute cholecystitis
In non-acute cases, medications such as ursodiol (ursodeoxycholic) may be recommended to dissolve gallstones or reduce the concentration of concentrated bile.
This drug will have good effects on small stones if it is used for two years and a low-fat and high-fiber diet is followed.
What is ESW?
In the case of small gallstones, the method of breaking the stone with the help of shock waves is sometimes used. Breaking the stones with the help of shock waves from outside the body is called ESW.
New treatments for gallstones include injecting solvent through the skin into the bile (percutaneous).
Although cholecystectomy is the treatment of choice in acute cases, but non-surgical methods can be used for people who for any reason cannot have surgery (open or laparoscopic)
What are the types of cholecystectomy to remove the gallbladder?
- Open cholecystectomy with a surgical knife incision and under general anesthesia:
In this case, the patient will be hospitalized one week after the operation and it will take about a month for him to return to normal life.
- Closed or laparoscopic cholecystectomy:
Nowadays, this method is almost preferred to open surgery. Without anesthesia and with complete analgesia, a few small holes are made in your abdomen and with a narrow instrument that is attached to the head of the camera and allows the surgeon to see inside the body, the gallbladder is removed. The duration of hospitalization and recovery is very short. Usually, the hospitalization will be a maximum of one night, and after a week, return to normal conditions and daily work will take place.
Other ways of non-surgical for gallstones
- Extracorporeal shock wave lithotripsy:
This method is sometimes used in combination with orthodoxy colic
- Oral consumption of gallstones:
This method is not a quick treatment for gallstones, it takes two years and must be accompanied by a low-fat, high-fiber diet.
- Occasionally ERCP (Advanced Endoscopy):
What happens if your gallstones do not come out?
We explained above how gallstones may cause sudden obstruction of the gallbladder or acute cholecystitis, unpredictable and recurrent attacks of chronic pain in the upper abdomen or chronic cystitis, inflammation of the bile ducts of the liver or cholangitis, and inflammatory bowel disease or acute pancreatitis
When to see a doctor?
In cases where you have the following symptoms:
- Sharp pain in the upper abdomen with spread to the middle of the abdomen and right shoulder and back
- nausea and vomiting
Immediate referral to a well-equipped medical center is mandatory.
Decisions about the type of treatment and preparation for surgery will be made by the surgery team
In cases of severe infection, delayed abdominal opening is performed after partial infection control.