Gallstones: Risks, Treatment Options, and Prevention Tips - Surgery

Dr. Huang Zhihui reply Surgery

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"Gallstones," more accurately referred to as "gallbladder stones," are a common condition.
According to foreign literature, approximately over 10% of the adult population has gallstones, and the incidence increases with age, with rates as high as 30-40% among the elderly.
However, many individuals remain asymptomatic throughout their lives and may not realize they have gallstones until death.
The likelihood of developing gallstones is significantly higher in women compared to men.
Additionally, patients with obesity, diabetes, hemolytic diseases, liver cirrhosis, and parasitic infections also exhibit a higher prevalence.
The exact cause of gallstone formation is not fully understood, but several contributing factors have been identified: (1) Abnormal bile composition: Bile consists of three main components: cholesterol, lecithin, and bile salts.
These components maintain a stable ratio to preserve solubility, keeping bile in a viscous liquid state.
When this balance is disrupted, cholesterol can precipitate and crystallize due to supersaturation, leading to gallstone formation.
Gallstones can be classified into three types based on their composition: cholesterol stones, pigment stones, and mixed stones.
Western populations tend to have a higher prevalence of cholesterol stones due to a diet rich in cholesterol, while pigment stones are more common in certain Asian populations.
(2) Bile stasis: The gallbladder's outlet is a narrow cystic duct.
If it becomes narrowed or obstructed, or if bile flow is impaired for other reasons, water, electrolytes, and bile salts can be absorbed by the gallbladder wall, leading to bile supersaturation and subsequent precipitation and stone formation.
(3) Infection of the gallbladder and bile ducts: Some evidence suggests that the formation of calcium bilirubinate stones, common in Eastern populations, may be related to infections by parasites like roundworms or bacteria such as E.
coli, which may secrete enzymes that promote the precipitation of free bilirubin and calcium.
The primary symptom of gallstones is upper abdominal pain, particularly in the right upper quadrant.
The pain is typically intermittent and colicky, often exacerbated after eating, especially after consuming fatty foods.
Sometimes, the pain may be felt closer to the stomach, leading to misdiagnosis as gastric pain.
The pain may also radiate to the right upper back and right shoulder blade.
On physical examination, tenderness is often noted in the right upper abdomen, especially during deep inhalation.
Some gallstones may lead to acute or chronic cholecystitis, presenting with symptoms such as nausea, abdominal bloating, abdominal pain, and vomiting.
In severe cases, fever, chills, jaundice, and even life-threatening conditions like acute suppurative cholecystitis, peritonitis, and sepsis may occur, often necessitating emergency surgery.
Diagnosing gallstones is generally straightforward, relying on a detailed medical history, symptom inquiry, and careful physical examination, supplemented by non-invasive abdominal ultrasound, which can easily confirm the diagnosis.
In cases of mild symptoms, fasting and rest may alleviate discomfort.
However, if severe pain, fever, or vomiting occurs, immediate medical attention is required.
Typically, unless there are severe septic symptoms, conservative management such as fasting, nasogastric drainage, intravenous fluids, anti-inflammatory medications (antibiotics), and analgesics can provide relief for most patients within a few days.
However, this merely controls the inflammatory condition temporarily and does not address the underlying issue.
Symptomatic gallstones often recur more frequently and with increasing severity, posing continuous risks to the patient's life.
Therefore, surgical removal of the problematic gallbladder along with the stones is the definitive treatment.
Regarding the difficulty and risks associated with surgery, older patients, those with severe inflammation, and those with multiple episodes of inflammation face higher risks and surgical challenges.
Thus, symptomatic gallstone patients should undergo surgical treatment as soon as inflammation is controlled.
As for asymptomatic gallstones, whether surgery is necessary remains a matter of personal judgment.

While surgery may seem daunting, laparoscopic cholecystectomy is now commonly performed by surgeons.
This minimally invasive procedure involves making four small incisions of less than one centimeter on the abdominal wall, akin to performing "microsurgery" with a magnifying lens.
Consequently, the surgical area is smaller, resulting in less tissue damage, reduced pain, and quicker recovery.
Most patients can mobilize the day after surgery and are typically discharged within two to three days, resuming normal activities within a week.
Therefore, it is advisable for individuals with a history of gallstone symptoms to consider early laparoscopic cholecystectomy.
Concerns regarding renal cysts and hepatitis B are not contraindications for this surgery, so such worries are unnecessary.
As for the prevention of gallstones, since the exact causes remain unclear, prevention can be challenging.
However, the formation of gallstones is closely linked to dietary habits.
Thus, adopting healthy lifestyle practices and a balanced diet is crucial for prevention.
Recommendations include: 1.
Maintaining an ideal weight, 2.
Engaging in regular physical activity, 3.
Eating at regular intervals and in appropriate portions, 4.
Avoiding excessive fatigue.
In terms of diet: 1.
Consuming high-fiber foods such as vegetables, fruits, and grains, 2.
Limiting intake of high-cholesterol foods like organ meats and egg yolks, 3.
Eating vitamin-rich foods such as spinach and broccoli, 4.
Reducing fried and greasy foods, 5.
Avoiding high-fat broths and mayonnaise, 6.
Drinking plenty of water, 7.
Opting for low-fat milk, and 8.
Steering clear of processed foods and those high in sugar.

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Reply Date: 2000/12/09