Gallstones Treatment

There is no permanent medical cure for gallstones. Although there are medical measures that can be taken to remove stones or relieve symptoms, they are only temporary. If you have symptoms from gallstones, surgical removal of the gallbladder is the best treatment. Asymptomatic gallstones usually do not require treatment.

After a diagnosis of gallstones, you may choose not to have surgery or you may not be able to have surgery right away. There are measures you can take to relieve the symptoms.

• Take clear liquids only to give the gallbladder a rest.
  
  
• Avoid fatty or greasy meals.
  
  
• Take acetaminophen (Tylenol) for pain.

Call your health care provider if your symptoms worsen or if new symptoms appear. Abdominal pain with vomiting, fever, or jaundice warrants an immediate visit to a hospital emergency department.

There are medical treatments for gallstones, but none works as well as surgery at getting rid of symptoms permanently and decreasing the risk of complications.

Extracorporeal shockwave lithotripsy (ESWL): A device that generates shock waves is used to break gallstones up into tiny pieces.

• These tiny pieces can pass through the biliary system without causing blockages.
  
  
• This is usually done in conjunction with ERCP to remove some stones.
  
  
• Many people who undergo this treatment suffer attacks of intense pain in the right upper part of the abdomen after treatment.
  
  
• We don't really know how well ESWL works compared with surgery.

Dissolving stones: Drugs made from bile acids are used to dissolve the gallstones.

• It may take months or even years for the gallstones to all dissolve.
  
  
• The stones often come back after this treatment.
  
  
• These drugs work best for cholesterol stones.
  
  
• They cause mild diarrhea in many people.
  
  
• This treatment is usually offered only to people who are not able to have surgery.

If you go to an emergency department, an IV line may be started, and pain medication and antibiotics may be given through the IV.

If your health permits it, your health care provider will probably recommend surgery to remove the gallbladder and the stones. Surgical removal helps prevent future episodes of abdominal pain and more dangerous complications such as inflammation of the pancreas and infection of the gallbladder and liver.

• If there is no infection or inflammation of the pancreas, the operation to remove the gallbladder can be performed immediately or within the next several days.
  
  
• If there is inflammation of the pancreas or infection of the gallbladder, you will probably be admitted to the hospital to receive IV fluid and possibly IV antibiotics for several days prior to the operation.

The usual treatment for symptomatic or complicated gallstones is surgical removal of the gallbladder. This is called cholecystectomy. See Gallstones, Outlook for more information about gallbladder surgery.

Many people who have gallbladder disease are understandably concerned about having their gallbladder removed. They wonder how they can function without a gallbladder.

• Fortunately, you can live without your gallbladder. In fact, you will hardly miss it.
  
  
• Living without a gallbladder doesn't even require a change in diet.
  
  
• When the gallbladder is gone, bile flows directly from the liver into the small intestine.
  
  
• Because there is nowhere to store bile, sometimes bile flows into the intestine when it is not needed. This does not cause a problem for most people, but causes mild diarrhea in about 1%.

Laparoscopic removal: Most gallbladders are removed by laparoscopic cholecystectomy. The gallbladder is removed through a small slit in the abdomen using small tubelike instruments.

• The tubelike instruments have a camera and surgical instruments attached, which are used to take out the gallbladder with the stones inside it.
  
  
• This procedure causes less pain than open surgery, is less likely to cause complications, and has a faster recovery time.
  
  
• A laparoscopic procedure is preferred if it is appropriate for the patient.
  
  
• The procedure is performed in an operating room with the patient under general anesthesia.
  
  
• It usually takes 20 minutes to 1 hour.
  
  
• A general surgeon performs the operation.

Open removal: The gallbladder is sometimes removed through a 3- to 6–inch incision in the right upper abdomen.

• The open procedure usually is used only when laparoscopic surgery is not feasible for a specific person.
  
  
• Common reasons for doing an open procedure are infection in the biliary tract and scars from previous surgeries.
  
  
• About 5% of all gallbladder removals in the United States are done as open procedures.
  
  
• This procedure is performed in the operating room with the patient under general anesthesia.
  
  
• It usually takes 45-90 minutes.
  
  
• A general surgeon performs the operation.

Occasionally, ERCP is done just before or during surgery to locate any gallstones that have left the gallbladder and are elsewhere in the biliary system. These can be removed at the same time as surgery, eliminating the risk that they might cause a complication in the future. ERCP also may be done after surgery if a gallstone is later found in the biliary tract. Sometimes ERCP is done without surgery, for example in people who are too frail or ill to undergo surgery.

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Kerry