Overview

A fact sheet all about gallstones

A gallbladder is a small bag that sits just under the liver and holds a liquid called bile. When we consume food, our gallbladder releases bile through the bile duct that goes into the intestines. When bile mixes with the foods that we have eaten it helps with digestion. Gallstones can develop in bile and can be the source of complications.

Gallstones are small ‘stones’ that form in the gallbladder. They are quite common. Some people have gallstones and are without symptoms but for others they result in frequent flare-ups of abdominal pain.

It’s very common to develop gallstones – reports show that one-third of women and 16% of men will suffer from gallstones at a time throughout their life. The condition is more common in women who are overweight or have had children. It is believed that as a result of changes in our diets in recent decades, as we consume more fatty foods, gallstones have become more common today.

Causes

What makes gallstones occur?

The first thing to understand is what bile actually is. It’s a mixture of different chemicals and when the bile can’t hold all of the chemicals in a liquid solution, solid gallstones begin to form. Gallstones start out as small crystals but can grow in size until they resemble something the size of a pebble. In some cases, there can be just a single stone, although often there are several.

Bile contains a high level of cholesterol, a fatty substance that can lead to diseases in the arteries. The human body produces bile as one way to clear the body of excess cholesterol, although there is sometimes too much cholesterol in the bile that is produced. When this happens, the cholesterol separates and forms small crystals that over time merge together to form a gallstone.

 

Image of a gallstone

What are the risk factors?

It’s very common for people who have gallstones not to realise that they are there. However, the most common risk factors are as follows:

  • Older age
  • Gender – gallstones are more common in females
  • Family history

Symptoms

What are the symptoms?

Studies show that around 66% of people have gallstones but don’t show any symptoms. It’s usually the case that gallstones are revealed when investigating another condition or having an operation close to the gallbladder location such as bariatric (weight loss) surgery. Symptoms usually only arise if the gallstones move from the gall bladder to the bile ducts that lead into the intestine.

 

 

Complications that can arise when this happens include:

  • Cholecystitis: if a bile duct becomes permanently blocked, this can lead to a build-up of bile in the gallbladder. When this happens the gallbladder can become seriously inflamed and infected.
  • Biliary colic: this is the most common symptom of gallstones. If the gallstones get stuck in the narrow neck of the gallbladder this can cause severe pain. The pain can be felt in the middle of the top of the stomach, or just below the ribs. The pain can be described as more severe than indigestion and can come in waves, although it is generally continuous. Usually, the pain gets worse after a meal or in the evenings.
  • Jaundice: this is caused when the body cannot flush out bilirubin, a yellow chemical that is produced naturally in the body. When red blood cells come to the end of their life, this produces bilirubin which is one of the body’s natural waste products. When the liver flushes out bilirubin it mixes it with bile. If there are gallstones blocking the bile duct, there can be a build-up of bilirubin and the eyes and skin can become a yellow colour.

Diagnosis

How are gallstones diagnosed?

Your doctor might begin to suspect the presence of gallstones if you report pain around the top of the abdomen that has been coming in waves, lasting for hours at a time. Furthermore, a visual examination for jaundice will be carried out, where the doctor will look for yellow pigment in the eyes or skin. As well as this, a physical examination will be carried out to determine if there is any pain/soreness present at the top of the abdomen.

If these examinations lead to a diagnosis of gallstones, you will need to go through some further testing. Most commonly, these tests include blood tests, an ultrasound scan or an MRI/CT scan (if the ultrasound scan is inconclusive).

Treatment

How do you treat gallstones?

If gallstones are present but not causing any complications or symptoms, you may not need to have them removed as it’s possible that the gallstones can travel through the body and passed naturally. However, if there are symptoms present, the gallstones will need to be removed. The easiest way to do this is to have gallbladder removal surgery. It’s important to note that the gallbladder is not an essential organ, and you can go on to live a happy, healthy and pain-free life after it’s been removed.

Gallbladder removal surgery

Gallbladder removal (known as cholecystectomy) is usually undertaken laparoscopically (keyhole) but there are a minority of cases that need to be done as open procedures. An open procedure would only usually be necessary when the gallbladder is found to be very inflamed. With our surgeons, over 99% of cases are successfully completed laparoscopically. The benefit of this is that you can usually go home the same day and expect a swift recovery. Most people are able to go back to work in 4 or 5 days assuming their work is not too strenuous.

The procedure is performed under general anaesthetic and usually takes no more than 30-60 minutes in theatre. Due to this, we have an age restriction of 75 for our procedures.

 

Benefits

Health benefits of gallbladder removal

There are several health benefits that come with gallbladder removal surgery, perhaps the most significant being that you will be free of pain!

  • Pain-free: the primary benefit of surgery is that you should be free of pain and able to eat a normal diet. Surgery should also prevent the longer term complications associated with untreated gallstones.
  • Swift recovery: most people can return to work within 4 to 5 days and are able to drive again after the same time period.
  • Normal Diet: as the gallbladder isn’t essential for digestion, most people can eat a normal diet straight away after their procedure. As always, we would advise a balanced and healthy diet. 

Recovery

How long does it take to recover?

Most people who have keyhole gallbladder removal surgery are able to leave hospital on the same day as the operation. It’ll usually take around 2 weeks to return to your normal activities but you’ll be able to drive and go back to work within 4 or 5 days.

You’ll be able to live a perfectly normally without a gallbladder, so usually, there aren’t any long-term side effects.

Temporary side effects can include:

  • painful wounds – this should improve within just a few days. We advise that you take normal painkillers such as paracetamol to help relieve any pain
  • feeling sick – as a result of anaesthetic it is quite common to feel sick but this should pass quickly as the anaesthetic wears off
  • stomach and shoulder pain – as a result of gas being used to inflate your tummy, you may feel discomfort in your stomach and shoulder area. This will pass after a couple of days
  • bloating and flatulence – this is completely normal and will pass within a week or so. We advise eating foods high in fibre to firm up your stools
  • fatigue – as a result of anaesthetic, it’s extremely common to feel fatigued during the first couple of days after your procedure. This will improve as you recover

 

All of these side effects are completely normal and will rapidly improve as you recover. They are not usually a cause for concern.

NHS

Gallbladder removal & the NHS

It’s no secret that the NHS is under more pressure than ever before. The likelihood is that if you are offered gallbladder removal on the NHS it could take up to 18 months to happen due to growing waiting lists.

Below is a graph showing the growing NHS waiting list for hospital treatment as a result of the coronavirus pandemic.

Source: NHS England