The gallbladder is a pear-shaped organ under the liver. It stores bile, a fluid made by the liver to digest fat. As the stomach and intestines receive food, the gallbladder releases bile to help digest fats in food. The bile travels through a tube (the bile duct) that connects the liver and gallbladder to the small intestine.
The gallbladder is most likely to give you trouble if something blocks the flow of bile through the bile duct. The culprit is usually a “gallstone” that blocks the duct. Gallstones form when substances in bile harden. Attacks usually happen after you eat.
Common symptoms associated with gallstones are a sharp pain in the upper right part of the abdomen that may go to the back, mid abdomen, or right shoulder; low fever; nausea and feeling of a bloated tummy; jaundice (yellowing of the skin) if stones are blocking the common bile duct.
Medical treatment of gallstones has been disappointing and therefore surgical removal of the gallbladder (cholecystectomy) is the best alternative. There are three methods used for removal of gallstones: a) “Open cholecystectomy” whereby the gallbladder is removed through an eight-inch long incision on the right side under the rib cage; b) “Laparoscopic cholecystectomy” where the gallbladder is removed with instruments placed into small incisions in the abdomen; and, c) “Endoscopic stone retrieval”.
Cholecystectomy relieves pain, treats infection, and stops gallstones from coming back. Today most surgeons are adept at performing successful laparoscopic cholecystectomies. This surgery uses a laparoscope (an instrument used to see the inside of your body) to remove the gallbladder. It is performed through several small incisions rather than through one large incision. With laparoscopic cholecystectomy, you can return to work sooner, have less pain after surgery, a shorter hospital stay, and a shorter recovery time. Another advantage is that it does not require the muscles of your abdomen to be cut – a definitive boon. Gallbladder removal is one of the most common operations performed in older adults.
Women are much more likely than men to develop gallstones. Hispanics and North Europeans have a higher risk for gallstones than do people of Asian and African descent. North Indians are affected with gall stones seven times more often than South Indians. While a person under 40 has about an 8 percent chance of developing gallstones, the risk jumps to more than 50 percent in people 70 years and older.
Research done at the University of Texas Medical Branch has brought to light some interesting findings. First, the researchers showed that a combination of factors – age, sex, race, other associated illnesses and severity of gallbladder symptoms, for example – put a patient in the most danger for acute gallbladder attack.
Recently, after analyzing the records of more than 160,000 patients, the researchers made some important observations. Their results were published in December 2014 Journal of the American College of Surgeons.
After dividing patients into low, moderate and high risk, they observed something difficult to explain. Patients in the “highest risk category” (who should have undergone voluntary gallbladder removal surgery because high chances of adverse potential consequences) were the ones who adopted a “nonchalant” attitude and refused anything, as long as they were apparently healthy. As many as 65 percent of them after opting out of any surgery in better times, had to be unfortunately hospitalized for dangerous emergency surgery within two years of the first symptoms and many lost their lives. In contrast, those who were in the “lower risk group” volunteered for surgery in greater numbers.
This research is important, because it can provide us with a starting point for individualized care and shared decision making. The overall message for symptomatic gallstone patients is, “Do not neglect. It is better to be safe than sorry”.
It is an entirely different story as far as “asymptomatic” gallstones are concerned. With ready availability of “abdominal ultrasonography” today, asymptomatic gallstones are being diagnosed with increasing frequency. Long-term follow up studies consistently show that only a small minority of asymptomatic gallstones lead to development of symptoms or complications. Those who have no symptoms need not rush for gallbladder removal.
I remember when we were young medical students, removal of appendices and tonsils was the bread and butter of the general surgeons. Today it is the same with gallbladder surgery (cholecystectomy). However, the Texas study provides food for thought… and caution. Waiting for too long may get you a passport to death.
(Dr. Francisco Colaço is a seniormost consulting physician, pioneer of Echocardiography in Goa, column writer, singer/songwriter/music aficionado, Mando exponent, past president of the state IMA, social activist, popular orator and toastmaster, family man, with deep faith in God.)
