In cases of gallstones with no symptoms, a policy of 'watchful waiting' is recommended. This means you will receive no immediate treatment, but you should look out for any worsening of your condition and report any symptoms to your GP.
As a general rule, the longer you go without experiencing any symptoms, the less likely it is that your condition will worsen.
The treatment plan for uncomplicated gallstone disease will depend on the frequency and severity of your symptoms, and the effect they have on your quality of life.
If your symptoms are mild and infrequent, and your quality of life is largely unaffected, surgery is not usually recommended. You may be prescribed painkillers, which you can use to control the symptoms if you experience another episode of biliary colic.
Surgery to remove your gallbladder will usually be recommended if your symptoms are more severe and occur frequently, leading to a reduction in your quality of life.
Whenever possible, surgery is recommended for all cases of complicated gallstone disease.
A cholecystectomy is the surgical removal of the gallbladder. There are two types of cholecystectomy:
- laparoscopic cholecystectomy
- open cholecystectomy
The most widely used type of cholecystectomy is laparoscopic cholecystectomy, which is a type of 'keyhole' surgery.
During a laparoscopic cholecystectomy, the surgeon will make four small incisions (cuts), each about 1cm or less, in your abdomen wall. One incision will be made by your naval (bellybutton) and the other three will be made across your upper abdomen.
Your abdomen will be inflated with carbon dioxide gas that is passed through the incisions. Inflating your abdomen gives the surgeon a better view of your organs and more room in which to work.
The surgeon will pass an instrument called a laparoscope through one of the incisions. A laparoscope is a small, flexible tube that has a light source and a camera at one end. The camera transmits images of the inside of your abdomen or pelvis to a television monitor.
The surgeon will then pass small instruments down the laparoscope which can be used to remove your gallbladder and any gallstones. Once the procedure is complete, the incisions will be sealed.
The advantage of having a laparoscopic cholecystectomy is that, as only small incisions are made in your abdomen, you will not experience much post-operative pain. You should also recover quickly from the effects of the operation. Most people are able to return home either on the day of the surgery or the day after.
In some circumstances, a laparoscopic cholecystectomy may not be recommended. This may be due to technical reasons or safety concerns. A laparoscopic cholecystectomy may not be recommended if:
- you are in the third trimester (the last three months) of your pregnancy
- you are obese
- you have cirrhosis (scarring of the liver)
- you have a condition that affects your blood's ability to clot (thicken), such as haemophilia
In these circumstances, an open cholecystectomy may be recommended. During this procedure, the surgeon makes a large incision in your abdomen and removes your gallbladder.
An open cholecystectomy is an effective method of treating gallstone disease, but it has a longer recovery time compared with laparoscopic cholecystectomy. Most people take about six weeks to recover from the effects of an open cholecystectomy.
A number of alternative treatments are available for people who are unable or unwilling to have their gallbladder removed.
However, many of these methods are only effective in a minority of people with gallstones (estimated at around 1 in 10). Therefore, if alternative treatments fail, you may still require surgery.
The alternative treatment methods for gallstones are described below.
Gallstones that are made of cholesterol can sometimes be treated using a medication called ursodeoxycholic acid, which slowly dissolves gallstones.
Ursodeoxycholic acid is also sometimes prescribed as a precaution against gallstones if it is thought that you have a particularly high risk of developing them. For example, you may be prescribed ursodeoxycholic acid if you have recently had weight-loss surgery.
Ursodeoxycholic acid is taken orally (in tablet form), and a course of treatment can last up to two years.
To increase the effectiveness of the medication, eating a low-cholesterol diet may be recommended. Your GP can give you more information about your diet.
Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are:
- itchy skin
The use of ursodeoxycholic acid is not usually recommended for pregnant or breastfeeding women.
Sexually active women should use either a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid. Other types of oral contraceptive pills are not recommended because they can sometimes interact unpredictably with ursodeoxycholic acid.
Endoscopic retrograde cholangiopancreatolography (ERCP)
Endoscopic retrograde cholangiopancreatolography (ERCP) is a procedure that aims to remove your gallstones without removing your gallbladder. It is usually carried out under a local anaesthetic, which means that you will be awake throughout the procedure but will not experience any pain.
ERCP is similar to a diagnostic cholangiography, except that an electrically heated wire is passed through the endoscope and is used to widen the opening to your bile duct. The gallstones are then removed or left to pass into your intestine.