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MY 1st Surgery: FIRST: GALL STONES

Updated: Feb 14


Yep that little green organ protruding from the liver gave me a ton of trauma, anxiety and almost cost me my life. It started with horrendous pain under my chest cavity and radiated through my back. I mean screaming pain. Turns out it was gall stones, infected Gall Bladder, Pancreatitis, and as if that weren't enough developed sepsis... not sure in what order all this occurred. I can tell you it was the worst pain I had ever felt. The first plan was to get the stones out.


Credit to Harvard Women's Health and Cleveland Clinic for both articles.

Gallstones are one of the most common digestive problems treated in women.

More than 25 million people in the United States have gallstones, and 65% to 75% of them are women. Fortunately, for most people, gallstones are "silent" — they don't cause major symptoms. When they do act up, there are effective ways to address the problem.

What are gallstones?

Gallstones begin with bile, a substance that helps with the digestion of fats and the absorption of certain vitamins. Bile is made in the liver and carried to the gallbladder, a small, pear-shaped organ that concentrates and stores it. The fat in food triggers the release of a hormone that causes the gallbladder to contract and release bile into the intestine.

Gallstones are solid lumps that develop when the stored bile crystallizes. Most are less than an inch in diameter, but they can be as small as a grain of sand or as large as a golf ball. Most gallstones are composed mainly of cholesterol. The rest — known as pigment stones — are made of calcium salts and bilirubin, a breakdown product of red blood cells.

Cholesterol stones form when liquid bile in the gallbladder contains more cholesterol than the bile salts can dissolve. Cholesterol stones may also develop if the gallbladder doesn't contract and empty as it should. Pigment stones are associated with certain medical conditions, including liver disease, some types of anemia, and infection of the bile ducts.

Gallstone trouble


Gallstones cause problems when they block any of the ducts carrying bile from the liver or gallbladder (or digestive enzymes from the pancreas) to the small intestine.

Why are women at greater risk?

It's the effect of female hormones. Estrogen increases cholesterol in the bile, and progesterone slows the emptying of the gallbladder. That may explain why the risk for women, relative to men,

decreases with age. Before age 40, women are diagnosed with gallstones almost three times more often than men are (pregnancy, for example, increases the risk), but by age 60, their risk is just slightly greater. Estrogen therapy increases the risk, especially when taken as a pill rather than a patch. Oral contraceptive pills also increase the risk slightly, but only in the first decade of use.

Obesity is another risk factor because bodies with more fat produce more estrogen. Paradoxically, rapid weight loss also increases the risk, because very low-calorie diets interfere with bile production and therefore cause more crystallization of cholesterol. Gallstones are so common after weight-loss surgery that patients may be advised to have their gallbladders removed at the same time. Gallstones are also more likely to occur in people with diabetes or any condition that decreases gallbladder contractions or intestinal motility, such as a spinal cord injury. Finally, there's some evidence for genetic vulnerability to gallstone formation.


What are the symptoms?

Most people who have gallstones don't know it. Their gallstones stay silent and may only be



discovered incidentally, through an ultrasound or CT scan performed for other reasons. Symptoms arise mainly when stones pass through a bile duct or obstruct it, causing biliary colic — better known as a gallbladder attack. These attacks occur when the gallbladder contracts (usually in response to a fatty meal) and presses the stones so as to block the gallbladder duct. The main symptom is pain, usually in the right upper or middle abdomen (just below the rib cage), which builds to greatest intensity within an hour and can persist up to several hours. It can be either sharp and knifelike or a deep ache; sometimes it radiates to the back or the right shoulder. There may also be nausea and vomiting. The pain subsides as the gallbladder relaxes.

A stone lodged in a duct can also cause more serious problems, including acute cholecystitis (inflammation of the gallbladder), pancreatitis (inflammation of the pancreas), or cholangitis (inflammation of the bile ducts in the liver). Any of these conditions can cause severe pain and other symptoms, including jaundice, high fever, chills, and vomiting. Treatment usually requires hospitalization and often surgical removal of the stone.

If you think you're having a gallbladder attack, your clinician will probably order several blood tests and an abdominal ultrasound (after you fast for at least eight hours). Ultrasound is particularly helpful in diagnosing acute cholecystitis because it also picks up any thickening of the gallbladder wall and indicates the presence of fluid, which may suggest inflammation. Other diagnostic techniques include cholescintigraphy, a radioactive injection used to view a possible blockage of the cystic duct; magnetic resonance imaging (MRI) of the bile ducts; endoscopic ultrasonography, which introduces an ultrasound device through the mouth, esophagus, and stomach to the duodenum (the first section of the small intestine) to get images of the area; and endoscopic retrograde cholangiopancreatography, which uses a scope inserted through the mouth to the duodenum to view the biliary ducts.


How are gallstones treated?

Typically, gallstones are treated only if they cause symptoms. For recurrent gallbladder attacks, the most effective treatment is surgical removal of the gallbladder, or cholecystectomy. In the past, the standard procedure was surgery requiring a five-inch incision and a hospital stay of up to a week. This approach has largely been replaced by laparoscopic cholecystectomy, in which the gallbladder is removed with instruments inserted through small incisions in the skin. This procedure requires only an overnight hospital stay and a week of recovery at home. However, there's a slight risk of injuring the bile ducts, and in a small percent of cases, the surgeon may have to switch to an open surgery with a larger incision because of complications.

You can easily live without a gallbladder. The liver produces enough bile for normal digestion. When the gallbladder is removed, bile simply flows directly into the small intestine through the common bile duct. When no food is present, loose stools may result, but you can treat that with a bile acid–binding medication, such as cholestyramine (Questran).


Medical options

If you can't or don't want to undergo surgery and your gallstones are small, one option is to take ursodiol (Actigall, Urso), a naturally occurring bile acid that helps dissolve cholesterol stones when taken by mouth two to four times a day. It's also used to prevent the formation of gallstones in people who are losing weight quickly. Ursodiol dissolves only those gallstones made of cholesterol, and it may take several months before it has an effect.

Drug therapy is occasionally combined with lithotripsy, in which sound waves from outside the body are used to break gallstones into pieces that dissolve more easily or are small enough to safely pass through the bile duct. Unfortunately, stones are likely to recur after medical treatment.

How can I reduce my risk for gallstones?

There's no proven way to prevent gallstones, but eating a well-balanced diet, maintaining a normal weight, and exercising regularly (at least 30 minutes a day most days of the week). Avoiding fatty foods won't prevent or get rid of gallstones, but it may reduce the frequency of attacks.


What are common bile-duct stones?

Common bile-duct stones are gallstones that move out of your gallbladder and get stuck in your common bile duct, which is a tube that connects your gallbladder and liver to your intestines. Gallstones are ‘stones’ that form in your gallbladder. They are common and can run in families.

Your liver produces a fluid called bile that is concentrated by, and stored in, your gallbladder.

When you eat food, your gallbladder empties bile into your intestines to help digest fats. Stones can develop in bile, particularly if you eat a diet rich in fat.

The position of the gallbladder.

What are the benefits of surgery?

You should be free of pain and able to eat a normal diet. Surgery should also prevent the serious complications that common bile-duct stones can cause.

Are there any alternatives to surgery?

An ERCP (endoscopic retrograde choledocho pancreatogram) is a procedure to examine your bile duct using a flexible telescope and dye (colourless contrast fluid).

It is possible to dissolve the stones or even shatter them into small pieces but these techniques involve unpleasant drugs that have side effects and a high failure rate.

Antibiotics can be used to treat any infection of your gallbladder and common bile duct. Eating a diet low in fat may help to prevent attacks of pain.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes 1 to 2 hours.

Your surgeon will first need to find out where the stones are in your common bile duct.

If your surgeon finds any gallstones in the duct, they will try to remove them through the cystic duct or the common bile duct. Various techniques can be used, including a wire basket or a tube with an inflatable balloon at the end (balloon catheter).

Your surgeon will remove your gallbladder. They will free up and secure your gallbladder duct (cystic duct) and artery, separate your gallbladder from your liver, and remove it.

How can I prepare myself for the operation?

If you smoke, stopping smoking now may reduce your risk of developing complications and will improve your long-term health.

Try to maintain a healthy weight. You have a higher risk of developing complications if you are overweight.

Regular exercise should help to prepare you for the operation, help you to recover and improve your long-term health. Before you start exercising, ask the healthcare team or your GP for advice.

Speak to the healthcare team about any vaccinations you might need to reduce your risk of serious illness while you recover. When you come into hospital, practise hand washing and wear a face covering when asked.

What complications can happen?

Some complications can be serious and can even cause death.

General complications of any operation

  • bleeding

  • allergic reaction to the equipment, materials, medication or dye

  • infection of the surgical site (wound)

  • blood clot in your leg

  • blood clot in your lung

  • chest infection

  • developing a hernia in the scar

Specific complications of this operation

Keyhole surgery complications

  • gas embolism

  • damage to structures such as your bowel, bladder or blood vessels

  • conversion to open surgery

  • surgical emphysema (crackling sensation in your skin caused by trapped carbon dioxide gas)

  • developing a hernia near one of the cuts

Bile duct exploration complications

  • leaking of bile after the tube is removed

  • infection of your skin around the tube

  • difficulty removing the tube

  • retained stones in your common bile duct

  • stones forming again in your common bile duct

  • narrowing of your common bile duct

Cholecystectomy complications

  • leaking of bile or stones

  • bowel injury

  • inflammation of the lining of your abdomen

  • bowel injury

  • continued bowel paralysis (ileus), where your bowel stops working for more than a few days

  • serious damage to your liver or its associated blood vessels

  • continued pain

  • needing to go to the toilet more often

  • tissues can join together in an abnormal way

Consequences of this procedure

  • pain

  • scarring of your skin, which may be unsightly

How soon will I recover?

You should be able to go home after 1 to 2 days if you had keyhole surgery or after 4 to 5 days if you had open surgery.

You should be able to return to work after 3 to 4 weeks, depending on how much surgery you need and your type of work.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the healthcare team or your GP for advice.

You should make a full recovery and be able to return to normal activities and eat a normal diet.

Summary

Gallstones are a common problem. An operation to remove your gallbladder and any stones in your common bile duct should result in you being free of pain and able to eat a normal diet.

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