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Surgery, the best choice

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Removal of the gallbladder not only eliminates symptoms but also prevents potential complications due to gall stones. DR. RAVINDRAN KUMERAN

Each year, over one lakh people in Tamil Nadu have their gallbladders removed surgically. Although it is a common operation, there are some misconceptions about what causes gallbladder problems.

Lowering fat in your diet can moderate the symptoms caused by gallstones and possibly spare you an operation. However, the low-fat diet is very restrictive. It is not quite a no-fat diet, but it places fairly stringent limits on one’s lifestyle and most people find it very difficult.

Also, even if diet is successful in alleviating the painful symptoms, it does not eliminate the problem.

Gallstones are still present and there is potential for complications. Typically, if there is a complication such as an infection, a patient would know it because he or she would experience symptoms of an infection — severe, unremitting pain and typically some fever.

Myths and facts

Many people believe that eating a fatty meal, spicy foods or foods high in cholesterol can cause gallstones. That is not true. Gallstones are caused by cholesterol and can cause a gallbladder attack, involving nausea, possibly even vomiting, after a fatty meal but the stones do not form because of eating a fatty meal.

Another misconception is that gallstones are always painful. While many complain of severe pain in the abdomen, often with bloating, nausea or vomiting, particularly after a fatty meal, some people with gallstones don’t experience any symptoms.

In fact people who have gallstones don’t know it at all. Many patients have their gallstones discovered by chance, during an ultrasound for gynaecological reasons, for example. Or, the stones may be discovered when the patient faces complications from having a gallstone.

Over the years, gallstones have been treated several different ways, including the use of medication and shockwaves, but the preferred method of treatment is surgical removal.

No one knows for sure why some people develop gallstones. They form because of a chemical imbalance between the three chemicals that form the bile stored in the gallbladder. However, it is unclear if this is a manufacturing problem or if it is genetically predetermined.

The classic textbook description of a person most prone to developing gallstones is “female, fat, fertile and 40”. Yet, men certainly develop gallstones and heredity or family background may be a factor, but isn’t exclusively the cause.

Complications

There is one absolute truth about gallstones: if you have them, but do not have symptoms, surgical removal is not warranted. Conversely if you have gallstones and symptoms, this is an indication for removal of the gallbladder. The reason is that simply removing the stones does not solve the problem that caused the gallstones. Also your symptoms could worsen if untreated. The gallbladder is a non-essential organ; it is not essential for digestion. The gallbladder stores bile, which is made by the liver.

Gallstones cannot only be quite painful, but can also give rise to other serious problems like cholecystytis, a serious condition that can result in a hospital stay.

The symptoms of cholecystytis are persistent pain, tenderness under the ribs, fever, often nausea and vomiting, and a general feeling of not being well.

If a gallstone passes from the gallbladder out of the cystic duct into the common bile duct, which leads into the intestine, it can cause pancreatitis or inflammation of the pancreas, which can be life-threatening. Gallstones can also lead to a serious infection called cholangitis in the bile within the liver itself. Cholangitis can be rapidly fatal. Therefore, someone who experiences pain from gallstones needs to be treated, not only to eliminate the symptoms but also to prevent such potential complications.

Laparoscopy

Now-a-days patients have their gallbladders removed laparoscopically. During laparoscopic surgery, the surgeon inserts miniaturised instruments and a laparoscope, a telescope-like camera, through several tiny incisions in the abdomen, including one in the bellybutton. Guided by images from the laparoscope, projected on a TV monitor, the surgeon can remove the gallbladder through a small incision in the belly button that is no bigger than a fingertip.

Laparoscopic surgery is not painless or pain-free, but it is minimally invasive and allows for less pain and a quicker recovery time than traditional surgery, which typically involves an incision of about eight inches below the right rib cage. Most patients who have laparoscopic surgery are back to normal within two weeks or sooner. After surgery, a patient usually goes back to being able to tolerate foods he or she could not earlier. If gallstones are left in place, chances of complications occurring are high. So removal of the gallbladder is definitely the treatment of choice.

The writer is a Consultant Gastrointestinal Surgeon based in Chennai.


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