Gallstone Removal

Overview :

Laparoscopic cholecystectomy

Surgery to remove the entire gallbladder with all its stones is usually the best treatment, provided the patient is able to tolerate the procedure. Over the past decade, a new technique of removing the gallbladder using a laparoscope has resulted in quicker recovery and much smaller surgical incisions than the six-inch gash under the right ribs that used to be standard. Not everyone is a candidate for this approach.

If a stone is lodged in the bile ducts, additional surgery must be done to remove it. After surgery, the surgeon will ordinarily leave in a drain to collect bile until the system is healed. The drain can also be used to inject contrast material and take x rays during or after surgery.

Endoscopic retrograde cholangiopancreatoscopy (ERCP)

A procedure called endoscopic retrograde cholangiopancreatoscopy (ERCP) allows the removal of some bile duct stones through the mouth, throat, esophagus, stomach, duodenum, and biliary system without the need for surgical incisions. ERCP can also be used to inject contrast agents into the biliary system, providing superbly detailed pictures.

Cholelithotomy

Rare circumstances require different techniques. Patients too ill for a complete cholecystectomy (removal of the gallbladder), sometimes only the stones are removed, a procedure called cholelithotomy. But that does not cure the problem. The liver will go on making faulty bile, and stones will reform, unless the composition of the bile is altered.

Ursodeoxycholic acid

For patients who cannot receive the laparoscopic procedure, there is also a nonsurgical treatment in which ursodeoxycholic acid is used to dissolve the gallstones. Extracorporeal shock-wave lithotripsy has also been successfully used to break up gallstones. During the procedure, high-amplitude sound waves target the stones, slowly breaking them up.