Gallstones detected in the gallbladder. Should surgery be performed for treatment?

The gallbladder is an organ responsible for storing bile, which helps digest fats. When the compounds in bile become imbalanced, sediment can form, turning into gallstones. This condition is mostly found in people aged between 40-60 years. Patients often worry whether surgery is the best treatment option. Here is some advice about treatment that patients with gallstones should know.

 

If you have these symptoms… it is a sign that you should see a doctor immediately

Although over 50% of patients show no symptoms, some may experience bloating, excessive gas, or intermittent abdominal pain around the epigastric area. The pain often intensifies, radiates to the chest, and extends to the back. Fever, nausea, and vomiting may also occur. To diagnose gallstones, an abdominal X-ray or ultrasound examination is required.

 

Finding gallstones does not always require surgery

For patients diagnosed with asymptomatic gallstones and no indication for surgery, doctors may advise on potential complications. However, if severe abdominal pain develops, along with yellowing of the skin and eyes or fever, immediate medical attention is necessary.

Other treatments besides gallbladder surgery include taking medications to dissolve the stones. However, because gallstones contain calcium, this treatment is often less effective, and patients may develop new gallstones.

 

Which patients should be treated with “gallstone surgery”?

For patients with symptoms but no gallbladder inflammation, surgery is considered when the patient is ready. In some groups, such as those with diabetes, chronic kidney failure, heart disease, or vascular disease, if gallstones are detected and left untreated, it may lead to gallbladder inflammation requiring emergency surgery, increasing the risk of complications.

For patients with gallstones and inflammation, surgery or antibiotics will be considered based on the doctor’s judgment. Some cases cannot undergo immediate surgery and require initial treatment until symptoms improve before surgery can be performed. These cases include patients with the following complications:

1. Patients with severe abdominal inflammation
2. Patients with blood clotting disorders
3. Patients with acute pancreatitis
4. Patients with severe heart or lung disease
5. Patients who cannot undergo general anesthesia

 

Which groups of gallstone patients may find surgery difficult?

1. Patients who have had previous abdominal surgery
2. Patients with severe acute cholecystitis
3. Patients with advanced liver cirrhosis
4. Pregnant patients
5. Patients with common bile duct stones

 

There are 2 methods for gallstone surgery as follows:

1. Open abdominal surgery involves an incision on the right side of the rib cage.
2. Laparoscopic surgery involves inserting instruments into the abdomen and performing surgery through a camera. This method causes less tissue damage and results in smaller surgical wounds.

 

Patients suitable for laparoscopic gallstone surgery

1. Patients with gallstones but mild symptoms
2. Patients with gallstones and chronic cholecystitis
3. Patients with acute cholecystitis
4. Patients with gallstones and cholecystitis without common bile duct stones
5. Patients with gallbladder polyps, especially multiple polyps or polyps larger than 1 centimeter

 

Advantages of laparoscopic gallstone surgery

1. Less pain compared to traditional open surgery
2. Shorter hospital recovery time
3. Faster return to daily life, study, and work without prolonged recovery
4. Smaller surgical wounds that heal faster
5. Fewer surgical complications such as wound infection, hernia at the surgical site, nerve damage to the abdominal wall, or postoperative pneumonia

 

Risks and side effects of gallstone surgery

• General surgical risks

1. Pain at the surgical site, which can be relieved with painkillers
2. Possible wound infection similar to other surgeries, depending on factors such as inflammation severity, underlying diseases, medication, and patient health
3. Complications from anesthesia, such as nausea, vomiting, throat irritation, or pain from intubation
4. Pneumonia due to inadequate breathing or inability to clear airway secretions
5. Deep vein thrombosis in the legs due to immobility

• Specific surgical risks

1. Bleeding during surgery, occurring in 0.11-1.97% of cases
2. Injury to other abdominal organs such as the common bile duct (0.26-0.6%), intestines (0.14-0.35%). This risk increases in patients with previous abdominal surgeries, gallbladder inflammation, or common bile duct stones
3. Bile leakage from small bile ducts on the liver surface, occurring in about 0.3-0.9%
4. Open surgery may carry the risks mentioned above but less frequently than laparoscopic surgery
5. Laparoscopic surgery may need to be converted to open surgery in about 1.9% of cases due to abnormal bile duct anatomy or severe disease such as gallbladder abscess, common bile duct stones, or uncontrollable bleeding
6. Postoperative hernia at the surgical site can occur with both surgical methods
7. Abdominal inflammation or liver abscess may develop

 

Preoperative and postoperative care for gallstone surgery

• Preoperative care

Patients will undergo thorough physical and psychological preparation, including X-rays, blood tests, electrocardiograms, or consultations with internal medicine specialists to prepare for surgery and anesthesia.

• Postoperative care

1. Avoid food and drink as per the doctor’s plan; fluids will be given intravenously during fasting
2. If experiencing pain, inform medical staff for pain relief medication. Use hands or a pillow to support the wound when coughing, sneezing, or moving to reduce pain
3. Start moving as soon as possible to stimulate bowel function and prevent intestinal adhesions. Practice coughing and deep breathing to prevent postoperative pneumonia
4. Diet progression:

• • Sip water
  • Consume liquid foods
  • Eat porridge or soft foods
  • Return to a normal diet within 7 days
• Hospital stay depends on individual patient condition, usually about 2-3 days
• Patients can resume normal activities about 7 days after surgery
• Exercise and sports can be resumed within 3-4 months after laparoscopic surgery; open surgery may require 5-6 months