How Gallstones Are Treated

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If you've been diagnosed with gallstones, you will most likely need treatment, unless they aren't causing any symptoms. In that case, your doctor will determine if treatment is necessary depending on your individual situation. If you do need treatment, surgery (cholecystectomy) is probably what your doctor will recommend.

Surgery

Surgery to remove the gallbladder is the most common way to treat symptomatic gallstones. In fact, gallbladder surgery, called cholecystectomy, is one of the most common surgeries that adults have.

Fortunately, you can live just fine without this organ. However, a very small percentage may experience diarrhea from the increase in bile flowing into the small intestine. In the overwhelming majority of cases, the bile flows directly from the liver through the ducts and into the small intestine, and there are no noticeable changes in digestion.

Laparoscopic Cholecystectomy

The standard surgery to remove your gallbladder is called laparoscopic cholecystectomy. For this operation, the surgeon makes several tiny incisions in your abdomen and inserts surgical instruments and a miniature video camera. The camera sends a magnified image from inside your body to a video monitor, giving the surgeon a close-up view of your organs and tissues.

While watching the monitor, the surgeon uses the instruments to carefully separate your gallbladder from your liver, ducts, and other structures. Your cystic duct is then cut and your gallbladder is removed through one of the small incisions.

Because the abdominal muscles are not cut during laparoscopic surgery, patients have less pain and fewer complications than they would have had after surgery using a large incision across the abdomen. You can often go home the same day, with a week's worth of restricted activity at home.

Open Cholecystectomy

If the surgeon discovers any obstacles to the laparoscopic procedure, such as infection or scarring from other operations, the operating team may have to switch to open surgery. In some cases, these obstacles are known before your surgery and an open surgery is planned.

It's called "open" surgery because the surgeon has to make a 5- to 8-inch incision in your abdomen to remove your gallbladder. This is a major surgery and may require up to a week's stay in the hospital and several more weeks to a month of recovery at home.

Open surgery is required in about 5 percent of gallbladder operations.

Potential Surgical Complications

The most common complication of gallbladder surgery is an injury to the bile ducts. An injured common bile duct can leak bile and cause a painful and potentially dangerous infection. Mild injuries can sometimes be treated nonsurgically. Major injury, however, is more serious and requires additional surgery.

If gallstones are in your bile ducts, the surgeon may use endoscopic retrograde cholangiopancreatography (ERCP) to remove them before or during the gallbladder surgery. Once the endoscope is in your small intestine, the surgeon locates the affected bile duct. An instrument on the endoscope is used to cut the duct, and the stone is captured in a tiny basket and removed with the endoscope.

Occasionally, a person who has had a cholecystectomy is diagnosed with a gallstone in the bile ducts weeks, months, or even years after the surgery. The two-step ERCP procedure is usually successful in removing the stone.

Procedures & Therapies

Nonsurgical approaches are used only in special situations, such as when your condition prevents using an anesthetic, and they are only used for cholesterol stones. Stones recur after nonsurgical treatment about half the time.

These treatments include:

  • Oral dissolution therapy: Drugs made from bile acid are used to dissolve the stones. The drugs—Actigall (ursodiol), for example—work best for small cholesterol stones that are limited in number. It may take months or years of treatment before all the stones dissolve, if they do at all. Both drugs cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.
  • Extracorporeal shockwave lithotripsy (ESWL): This treatment uses shock waves to break up stones into tiny pieces that can pass through the bile ducts without causing blockages. Attacks of biliary colic (intense pain) are common after treatment, and ESWL's success rate is not very high. Remaining stones can sometimes be dissolved with medication. This treatment is rarely used.
  • Endoscopic retrograde cholangiopancreatography (ERCP): As mentioned above, sometimes surgeons will use ERCP, a combination of endoscopy and X-rays, to remove stones from the common bile duct.
  • Percutaneous cholecystostomy: This minimally invasive procedure involves placing a catheter in your gallbladder to relieve inflammation, often until you are able to have surgery or another treatment. Some stones can even be removed through the catheter after a few weeks by making the track big enough to allow for extraction, but this method isn't used often.

    Alternative Medicine

    Although research on the use of alternative medicine in treating or preventing gallstones is limited, the following natural options may help protect against developing gallstones again:

    Fiber

    Research suggests that following a diet rich in fiber may help keep the cholesterol in bile in liquid form, preventing gallstone formation. By increasing your consumption of both soluble and insoluble fiber, which reduces the absorption of deoxycholic acid by producing a favorable shift in the triad of factors that control cholesterol's solubility in bile, you can potentially lessen your risk of developing gallstones.

    Soluble fibers that are effective include guar gum and pectin, as well as other types of fiber, including oat bran, wheat bran, and soy fiber. Fruits and vegetables are great sources; the benefit of fiber is seen in the low incidence of gallstones in vegetarians. Other fiber sources include whole grains, legumes, psyllium seeds, and flaxseeds.

    Vitamin C

    In a study of 2,129 random adults, researchers found that a lower prevalence of gallstones is associated with taking regular vitamin C supplements. That said, the overall body of research hasn't proven that the vitamin works to thwart gallstones. Vitamin C, which is essential for converting cholesterol to bile acids, is available in a number of fruits and vegetables (including citrus, berries, broccoli, and kale), as well as in supplement form.

    Milk Thistle

    Silibinin, a compound found in the herb milk thistle, has been found to reduce cholesterol levels in bile, which may, in turn, keep gallstones from forming. However, the data on this is very limited and this effect is not proven. Also, be aware that some people are allergic to milk thistle.

    Consult Your Doctor

    Due to the limited research, it's too soon to recommend any form of alternative medicine to treat or prevent gallstones. It's also important to note that self-treating a condition and avoiding or delaying standard care may have serious consequences.

    If you're considering using alternative medicine, make sure to consult your physician first, especially because some approaches can interfere with others. That said, fiber is a key dietary component, and increased amounts are typically OK for most people.

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