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Gallstones

• Overview
• Symptoms
• Treatment
• Prevention

Alternative Names:

Cholelithiasis

Treatment:

Modern advances in surgery have revolutionized the treatment of gallstones. In general, surgery is used only if you have symptoms.

In the past, open cholecystectomy (gallbladder removal) was the usual procedure for uncomplicated cases. This operation required a medium-to-large incision just below the right lower rib in order to get to the gallbladder. After this operation, a patient typically spent 3 - 5 days in the hospital recovering.

However, a minimally-invasive technique called laparoscopic cholecystectomy was introduced in the 1980s, which uses small incisions and camera guidance to remove the gallbladder.

Currently, laparoscopic cholecystectomy is the gold standard for treating gallstones that cause symptoms and is one of the most common operations performed in hospitals today. Using this approach, a patient may have the gallbladder removed in the morning and be discharged from the hospital on the same evening or the next morning.

In addition, gallstones blocking the common bile duct may be seen and removed during the laparoscopic procedure. Because this surgical treatment method has a complication rate of less than 1%, it is preferred to using medication to treat gallstones.

MEDICATION

In people with a functioning gallbladder, bile salts taken by mouth may dissolve gallstones. However, the process may take 2 years or longer, and stones may return after the therapy is ended.

Medical dissolution, using both high-dose and low-dose chenodeoxycholic acids (CDCA, chenodiol) was an approach investigated in the early 1980s. However, it was successful in only 14% of cases and required a long period of administration and a lifetime of maintenance therapy.

Ursodeoxycholic acid (UDCA, ursodiol) is successful in only 40% of cases. Both CDCA and UDCA therapies are useful only for gallstones formed from cholesterol.

Other chemical methods include contact dissolution, in which a catheter is passed through the abdominal wall and into the gallbladder. Methyl tert-butyl ether, a volatile chemical, is then instilled. This chemical rapidly dissolves cholesterol stones, but potential toxicity, stone recurrence, and other complications limit its usefulness.

LITHOTRIPSY

Electrohydraulic shock wave lithotripsy (ESWL) has also been used to treat gallstones. In this method, electromagnetic high-energy shock waves break up the stones.

This approach was particularly popular in the mid-to-late 1980s, when some studies found it to clear gallstones in up to 60% of patients. However, its application is limited if there are a large number of stones present, if the stones are very large, or in the presence of acute cholecystitis or cholangitis. It can also be used in association with UDCA to improve its effect.

Expectations (prognosis):

Gallstones develop in many people without causing symptoms. The chance of symptoms or complications from gallstones is about 20%. With current surgical approaches, the outlook is excellent for people with symptoms -- over 99% of patients have no recurrence of symptoms.

Complications:

• Cholecystitis - acute
• Cholecystitis - chronic
• Cholangitis
• Choledocholithiasis
• Pancreatitis

Calling your health care provider:

Call for an appointment with your health care provider if you have pain in the right upper quadrant of your abdomen, jaundice, or other symptoms of gallstones.

• Review Date: 10/27/2005
• Reviewed By: Courtney W. Houchen, M.D., Division of Gastroenterology, Washington University School of Medicine, St. Louis, MO. Review provided by VeriMed Healthcare Network.

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