Gallbladder Stones

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Surgery Type

Robotic or Laparoscopic

Recovery Time

2 Weeks

Surgery Time

1-2 Hours

The gallbladder is a pear shaped small membranous sac, serves as a reservoir to store bile, and situated beneath liver on the right side. Approximately 1000 mL of bile is produced by the liver per day and gallbladder has a capacity to store bile about 50ml.Bile is a concentrated green-yellow fluid, required for digestion. Cholesterol, bilirubin, and bile salts are the important constituents of bile Bile produced by the liver passes through the tiny channels that eventually lead into a larger tube called the common bile duct, which leads into the duodenum, proximal part of small intestine, where it mixes with food.

Important function of bile

(1) Bile assist in fat metabolism
(2) Bile is also required to excrete certain substances, such as bilirubin, specific drugs, and toxins
A hormone called cholecystokinin causes the gallbladder to contract and deliver bile into the intestine. The gallbladder consists of three sections: the fundus, body, and neck.

Gall Stones: 40% patients are suffering from gall stones. Gallstones are crystallized or solid concretions form inside the gallbladder. Stone formation only takes place when the gallbladder is diseased or not working properly. About 80% patients carrying gall stones remains asymptomatic.Biliary pain, however, will develop annually in 1% to 2% of individuals who were previously asymptomatic. Those who started to develop symptoms may continue to have major complications (cholecystitis, choledocholithiasis, gallstone pancreatitis, cholangitis) occur at a rate of 0.1% to 0.3% yearly.

Gallstones form due to the crystallization of excess cholesterol in bile , sluggish emptying of bile from the gallbladder, biliary obstruction from various causes, such as strictures in the bile duct or neoplasms, may also lead to gallstones.

Size of gall stones: Some patients have few to hundreds of tiny gallstones. Other patients will have a single gallstone as large as 3 to 5cm. No matter what the size of the stone, it is important that symptomatic stones can lead to more serious complications of gallbladder disease, electively planned surgery after the diagnosis of stone tend to have fewer complications and a shorter recovery.

Based on the type of compositions, there are

2 main types of gallstones

Cholesterol gallstones: The liver secretes too much cholesterol into the bile, which becomes supersaturated with cholesterol. Due to Impaired contractility of diseased gallbladder, bile may not be able to release normally and becomes stagnant. The cholesterol gallstones basically composed of cholesterol but it may contain other components. Cholesterol gallstones are the most common type of gallstones. The color of the cholesterol is usually yellow or white as it mainly consists of fat and cholesterol

Pigment gallstones: These stones formation takes place only when bile contains too much bilirubin and these stones are dark brown or black in color

Mixed pigmented stones: The third type of gallstones is mixed pigmented stones, a combination of calcium substrates such as calcium carbonate or calcium phosphate, cholesterol, and bile.

Causes of gallstones

There are three main mechanisms in the formation of gallstones:

Normally, bile contains enough chemicals to dissolve the cholesterol excreted by the liver. But if the liver excretes more cholesterol than bile can dissolve, the excess cholesterol may form crystals and eventually stones.

Bilirubin is a chemical produced after the breakdown of red blood cells. Certain liver diseases like liver cirrhosis, biliary tract infections, and blood disorders make too much bilirubin and the excess bilirubin contributes to gallstone formation.

Impaired contractility of the gallbladder prevents the bile emptying and concentrated bile contributes to the gall stone formation

Causes of gallstones

Pregnancy (decreased contractility of the gallbladder due to Progesterone)

Obesity (increased biliary secretion of cholesterol)

Genes

Hormone replacement therapy and certain medications (estrogens and somatostatin analogs)

Stasis of the gallbladder

Female gender (Estrogen increases bile cholesterol and decreases gallbladder contractility)

Metabolic syndrome

Rapid weight loss (biliary stasis)

Prolonged fasting

Complications of gallstones

Diabetics are more susceptible to infections, due to high blood sugar levels. The morbidity and mortality in diabetes are mostly due to severe inflammation in diabetes and silent presentation.
If you are diabetic, you need surgery on priority basis. In the diabetic patient’s pain is not common and infection in the gallbladder can happen due to poor supply of blood, which leads to severe complications like empyema, gangrene, and severe infections
Gallstones can block any duct of the biliary system that carry bile especially the cystic duct which enters into the common bile duct, these obstructions can aggravate the symptom like biliary colic, inflammation and infection.
Gallbladder inflammation leading to cholecystitis:

Cholecystitis: When stone blocks the gallbladder due to inflammation severe pain in the right upper quadrant of abdomen is often experienced by the patients. This condition is cholecystitis.

Choledocholithiasis: This condition is very rare and only 10% of symptomatic gallstone patients landed up with these complications. In this condition gall stone obstruct the common bile duct and prevent the flow of bile which causes jaundice

Other complications and related biliary tract conditions:

Gallbladder Cancer: It appears from the current available evidence that there is a strong association between large gallstones and gallbladder cancer1. Larger stones (> 3 cm) have the greatest risk of developing gallbladder cancer, especially in patients with symptomatic gallstone disease. 1. Annals of Medicine and Surgery (Volume 61, January 2021, Pages 93–96)
Approx. 80% of people with gallbladder cancer suffer from symptomatic or asymptomatic gallbladder stone diseases. Gallbladder cancer is not very common but prognosis of gallbladder cancer is poor. Symptoms of gallbladder cancer appear once the disease has reached an advanced stage. Most common symptoms are involuntary weight loss, loss of appetite, recurrent vomiting and anemia. At early stage before the spread of cancer beyond the mucosa (inner lining), removing gallbladder can reduce the mortality. Elective surgery of gallbladder stones can avoid these life-threatening complications

Gallbladder polyps

Tissue growth that protrude from the gallbladder wall into the gallbladder interior are known as polyp. Gallbladder polyps are an incidental ultrasound finding.
Gallbladder polyps are of two types :
Benign polyps:
Malignant Polyps
Polyps less than 3 cm and not causing symptoms can be monitored via ultrasound. Gallbladder polyps can cause acute cholecystitis and exhibit symptoms of pain, indigestion, and discomfort. Surgery is recommended to avoid complications.

Why Choose Dr. Aloy J Mukherjee for Gallbladder Stone Surgery?

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