Dear Dr. K: My doctor says my stomach pains are caused by gallstones and I need surgery to remove them. Can you describe the surgery?
Dear Reader: Gallstones are small, hard clumps of cholesterol, calcium and various proteins. They form inside the gallbladder, a pouch that collects bile (a fluid containing cholesterol and bile salts that helps with digestion). Bile flows from the liver to the intestine through the bile ducts. When there is too much cholesterol relative to bile salts, the liquid bile hardens into stones.
Most people never get gallstones - and most of those people who do get gallstones don't know it because the gallstones never cause bothersome symptoms. Small stones can sometimes pass out of the gallbladder and into the intestine through a little tube called the cystic duct. If gallstones are small enough to pass through the duct without becoming stuck, they cause no symptoms.
Sometimes, though, gallstones do cause symptoms. They can get stuck in the opening from the gallbladder to the cystic duct, or inside the cystic duct itself. And sometimes they get stuck in another duct that leads to the pancreas. Wherever they get stuck, until they get unstuck they can cause pain.
Gallstones can also cause bacterial infections of the gallbladder. When this happens, the symptoms won't go away until the gallbladder is removed.
By far the most common treatment for gallstones is a type of surgery called laparoscopic cholecystectomy. The surgery removes the gallbladder and all the stones inside it. In this procedure, a surgeon makes a small incision in the wall of the abdomen. A tube with a small light and video camera at the end (a laparoscope) is placed through the incision into the abdomen. This allows the surgeon to see inside the abdomen and the gallbladder, via images projected on a video screen.
The surgeon then makes other small incisions in the abdomen, through which tiny instruments are placed. The instruments can grasp tissue or push it away. They can cut tissue, and place staples in tissue to close up any holes caused by the cutting.
First, the surgeon removes fluid and stones from the gallbladder to deflate it. Next, the surgeon removes the gallbladder and pulls it out of the body through one of the holes in the abdomen. (I've put an illustration of this procedure on my website, AskDoctorK.com.)
Some patients have their gallbladders removed through a larger incision in a type of surgery called open cholecystectomy. The recovery from this type of surgery is slower, and more blood is lost.
Usually, patients leave the hospital the same day they have laparoscopic surgery. You'll need to rest and avoid activities or sports that increase the pressure inside your abdomen for a week or more. With traditional open cholecystectomy, the recovery is slower. That's why the advent of laparoscopic surgery in the past 25 years has been a major advance.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.