CINCINNATI—About 10 percent of Americans live with gallstones, but not all of them experience painful gallbladder attacks or need surgery to remove their gallbladder. So what’s the overall risk of gallstones—and why do they require surgery?
UC Health surgeon David Fischer, MD, says surgery to remove the gallbladder, or cholecystectomy, is a very common procedure that is well tolerated in patients and can prevent much more serious complications in the future.
Normally, the gallbladder sits in the upper right abdomen, just under the liver, and stores and releases bile to be used in digestion. A functioning gallbladder will release bile after a meal or throughout the day to assist in digestion. Sometimes, substances called gallstones form in the gallbladder.
While gallbladder problems are most common among women, Fischer says they can occur in both men and women and at any age. They also can occur at any time:
"Gallbladder attacks are really a symptom of a gallbladder that is obstructed by gallstones,” he says. "During an attack, gallstones obstruct the cystic duct that normally drains the gallbladder, causing the gallbladder to become inflamed—that’s what causes the symptoms.
"When the gallstones move away and relieve the obstruction, you feel better. Attacks happen more frequently after eating, because the gallbladder is more active after eating. But they can happen during sleep or after eating seemingly healthy foods. It’s more of a mechanical issue."
Fischer adds that it doesn’t matter how many gallstones a patient has or how big they are—it only takes one to cause an obstruction.
Gallstones are typically made up of cholesterol, though they are unrelated to the person’s overall cholesterol level. Fischer says gallstones are more correlated with how your body manages cholesterol, which could explain why gallstones tend to cluster in families. It also explains why gallstones are more prevalent in people who have had sudden weight loss and are breaking down more fatty compounds in their body.
People with certain blood disorders can also have pigment gallstones, comprised of bilirubin, a dark red pigment leftover from destroyed blood cells.
"We know that about half the people who have gallstones are having symptoms,” says Fischer. "If you’re having symptoms, that’s an indication for surgery, though not necessarily urgently. Classic symptoms include right upper-quadrant abdominal pain after meals, usually crampy or colicky in nature, and after eating fattening or greasy foods.”
The pain also can move to the side or back and come with bloating or nausea. Attacks typically subside within a few minutes or a few hours.
"Occasionally the gallstones pass through the gallbladder into the bile ducts,” says Fischer. "If that happens, they can become lodged in the bile ducts and cause the liver to back up, causing jaundice, or block the pancreas, causing pancreatitis. As gallbladder attacks can be predictive of future gallbladder issues, including infection, the safest course of action is often to remove a symptomatic gallbladder."
Fischer says most patients arrive in his operating room after a consultation with their primary care physicians. Family doctors can identify gallbladder symptoms and order an ultrasound—an easy, inexpensive and noninvasive way to view gallstones in the body.
Currently, gallbladder removal is almost always done laparascopically. The surgeon makes small incisions in the abdomen. Using laparoscopic tools inside the centimeter-long incisions, the surgeon clips the ducts and arteries connected to the gallbladder and removes the organ.
Fischer says the entire surgery takes about an hour and patients typically return home that day.
"It’s generally a well-tolerated surgery,” he says. "The majority of patients go back to eating whatever they want within weeks. Some may have to be a little bit more cautious with higher-fat or greasy foods, as they may experience minor GI symptoms afterward. But most people will be able to determine for themselves what foods they don’t do well with.”
For some patients, escalating gallbladder attacks can indicate a serious infection that needs to be treated urgently.
"If the symptoms aren’t going away; if, in fact, they are getting worse—and especially if they are associated with fever or tenderness of the abdomen, patients should be seen right away by their primary care physician or potentially in the emergency department,” says Fischer.
A gallbladder infection, known as acute cholecystitis, often requires a round of antibiotics before gallbladder surgery, or may require emergency surgery that day. Those operations can require several days in the hospital.
But whether they have an inpatient or outpatient procedure, Fischer says the majority of
patients do not lose any GI function after gallbladder removal.
"The liver still makes all the bile you need, and we’ve even seen that the bile ducts can enlarge over time to compensate for losing the gallbladder,” he says. "At first, patients may be a little less efficient at digesting certain foods, but they adjust over time.”