Gallstones are common and can be painful- but effective treatments are available

The gallbladder is a small organ attached to the liver that stores and releases bile into the intestines. The liver produces bile that aids the digestion of fatty foods. While normally watery, bile can become thick and produce gallstones that cause problems.

Gallstones are present in 10-15 percent of the population with three times as many women as men affected. The vast majority of those with gallstones will never develop symptoms from them, and only 20-30 percent of patients with asymptomatic stones will develop symptoms within 20 years. Risk factors for the development of gallstones include age, female sex, and obesity. Gallstones are best detected with an ultrasound.

The main problems caused by gallstones include intermittent episodes of pain and nausea, acute or chronic inflammation of the gallbladder, bacterial infection of the bile ducts, and acute inflammation of the pancreas. Patients typically experience severe pain in the upper abdomen just beneath the breastbone or under the right rib cage. Other symptoms may include nausea, vomiting, fever, and yellow skin.

Other gallbladder problems may arise in the absence of stones including poor emptying, polyps, acute inflammation, and cancer. Polyps are often discovered incidentally and usually do not cause symptoms but do require monitoring.

Asymptomatic gallstones may be followed with observation. Currently, there is no effective way to eliminate gallstones without surgery. Attempts to dissolve them with medications or extracorporeal shockwave lithotripsy (which succeeds with kidney stones) yields recurrence rates of 20-50 percent.

Fortunately, there is a safe and minimally invasive way in which to treat gallstones. Laparoscopic cholecystectomy entails removing the gallbladder using four small incisions on the abdominal wall. The operation has a very low complication rate. When done electively, the patient often may be discharged the same day or, at most, will stay overnight in the hospital. If the surgery is done emergently, patients stay one to three days in the hospital.

Occasionally patients require another procedure prior to surgery called an ERCP (endoscopic retrograde cholangiopancreatography) in which the bile duct is accessed with a scope from inside the upper intestinal tract to remove stones stuck in the main bile duct. In the uncommon event that the surgeon is unable to safely remove the gallbladder with the laparoscope, a large incision in the upper abdomen will be required (open cholecystectomy).

Key points to remember:

• If you have gallstones but no symptoms, you do not need surgery.
• If you have gallstones and symptoms, it is best to have the gallbladder removed electively to prevent complications from the stones.
• If you have any sort of abdominal pain, contact your doctor. If the pain is severe, persistent and accompanied by nausea/ vomiting, fever/chills, or jaundice, go to the emergency room.

Anthony S. Oliva, M.D., F.A.C.S., is a general surgeon at St. Joseph's Health in syracuse, NY, and has been a member of the Catholic Medical Association since 2008. A graduate of Boston University Medical School, he redises in Manlius, NY, with his wife and five children.