Gall stones are increasingly emerging as a major health problem. Eighteen per cent of Indian females and 9 per cent of males suffer from gall stones (Over all incidence of 12%). This is higher than the average incidence of 8%. in US and Western Europe. The problem has definitely affected the quality of life in terms of pain the patient has to go through and the complications that may result because of gall stones. To undergo the right treatment, the patient must understand the nature of the illness and correct treatment options available.
Why do gall stones form?
In addition to bile acids, the liver secretes cholesterol and bilirubin into the bile and herein lies the main problem. Cholesterol is not always a stable solution, even in perfectly healthy people and can crystallize to form stones. More commonly this occurs due to excess of cholesterol as seen in obese individuals or even dehydration which reduces the water content of bile to precipitate formation of stones. The cholesterol stones are thus commonest type of stones seen. The other types of stones are those arise from bilirubin excess (pigment stones) seen in setting of hemolytic anaemia or infection.
Are there any risk factors which help in formation of stones?
Yes, there are definite risk factors
- Changing dietary habits.
- Pregnancy increases risk of gall stones, but oral contraceptive pill does not.
- There is general agreement that obesity causes stones, but even more so is the rapid weight reduction caused by a stringent diet or bariatric surgery.
- No particular food has been incriminated in the formation of stones. Nevertheless, vegetarians have fewer stones.
What are the complications which can arise from gall stones?
- acute cholecystitis (a febrile illness with pain in right upper part of tummy), resulting from infection.
- biliary colic (pain in top centre of the tummy) due to disturbed motility and spasm of gall bladder.
- jaundice (often painful) due to the stone migrating and blocking the bile duct carrying bile to the intestines.
- acute pancreatitis due to stones blocking the pancreatic duct (another very important organ working in digestion) which joins the bile duct as it enters the gut. How to diagnose gall stones?
The CT (CECT) scan of the abdomen is now considered the standard for diagnosis of gall stone disease.
What is the treatment for gall stones?
Medical-- Tiny Cholesterol gall stones can be dissolved by a medicine called Ursodeoxycholic Acid, but patient may be required to take the medicine for up to two years. Yet gall stones may recur once the drug is stopped, hence not a good option.
Surgical--Cholecystectomy (removal of gall bladder by surgery) is the treatment of choicem & has a 100% chance of eliminating the recurrence of gall stones. Removal of gall bladder doesn't have any negative consequences in majority of patients.
There are two surgical options available for cholecystectomy.
Open chloecystectomy-- This is performed via a 15-25 cm cut made into abdomen just below the right lower ribs. Recovery typically consists of 3-5 days of hospitalization, with return to normal diet within a week and normal activity several weeks after discharge.
Laparoscopic cholecystectomy-- This has become the Gold standard for treatment of gall stones & is performed via 3 to 4 (0.5 to 1 cm) puncture holes in the abdomen. It needs special instruments & surgeon trained in laparoscopic surgery. Post operative care typically includes a same day discharge or a night of hospital stay, followed by 3-4 days of medications and return to work within a week.
Complication rate is less than 0.5% with open cholesystectomy and about 1% with laparoscopic cholecystectomy. Primary complication with the open technique is infection whereas bile leak and hemorrhage are the most common complications associated with laparoscopic technique.
What are the advantages of Laparoscopic surgery?
It has faster recovery after surgery, lesser hospital stay (avg. 2 days) resulting in lower costs but needs an expert surgeon who is experienced in laparoscopic surgery.
Another big advantage is avoidance of large ugly scars left after surgery for the rest of patient's life, only small scars of subcentimeter size are left which are not even seen!.
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