Gallstones (cont.)

Medical Author:

Jerry R. Balentine, DO, FACEP

Jerry R. Balentine, DO, FACEP

Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The usual treatment for symptomatic or complicated gallstones is surgical removal of the gallbladder. This is called cholecystectomy.

Many people who have gallbladder disease are understandably concerned about having their gallbladder removed. They wonder how they can function without a gallbladder.

• Fortunately, you can live without your gallbladder.
  
  
• Living without a gallbladder does not require a change in diet.
  
  
• When the gallbladder is gone, bile flows directly from the liver into the small intestine.
  
  
• Because there is nowhere to store bile, sometimes bile flows into the intestine when it is not needed. This does not cause a problem for most people, but causes mild diarrhea in about 1% of patients.

Laparoscopic removal: Most gallbladders are removed by laparoscopic cholecystectomy. The gallbladder is removed through a small slit in the abdomen using small tube-like instruments.

• The tube-like instruments have a camera and surgical instruments attached, which are used to take out the gallbladder with the stones inside it.
  
  
• This procedure causes less pain than open surgery.
  
  
• It is less likely to cause complications, and has a faster recovery time.
  
  
• A laparoscopic procedure is preferred if it is appropriate for the patient.
  
  
• The procedure is performed in an operating room with the patient under general anesthesia.
  
  
• It usually takes 20 minutes to one hour.
  
  
• A general surgeon performs the operation.
  
  
• In some cases a laparoscopic procedure is started and then changed to an open abdominal procedure (see below).

Open removal: The gallbladder is sometimes removed through a 3 to 6 inch incision in the right upper abdomen.

• The open procedure usually is used only when laparoscopic surgery is not feasible for a specific person.
  
  
• Common reasons for doing an open procedure are infection in the biliary tract and scars from previous surgeries.
  
  
• About 5% of all gallbladder removals in the United States are done as open procedures.
  
  
• This procedure is performed in the operating room with the patient under general anesthesia.
  
  
• It usually takes 45 to 90 minutes.
  
  
• A general surgeon performs the operation.

Occasionally, ERCP is done just before or during surgery to locate any gallstones that have left the gallbladder and are located elsewhere in the biliary system. These can be removed at the same time as surgery, eliminating the risk that they might cause a complication in the future. ERCP also may be performed after surgery if a gallstone is later found in the biliary tract. Sometimes ERCP is done without surgery, for example in people who are too frail or ill to undergo surgery.

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