Gallstones Removal

Gallstones are hard aggregations (stones) in the gallbladder. There are two types of gallstones – cholesterol stones and pigment stones.

Cholesterol stones are by far the commonest type of gallstone and can account for more than 90% of the gallstones we see in Singapore. These stones are formed as a result of over-concentration of cholesterol in the bile, leading to crystallisation of cholesterol salts and eventually forming cholesterol stones. It is important to note that the formation of gallstones is not strongly related to high blood cholesterol levels. Individuals with or without high blood cholesterol levels are at largely equal risk of forming cholesterol stones and they tend to develop such stones in their late 30s and onwards.

Pigment stones only account for a very small percentage of gallstones. These stones are formed as a result of high bilirubin levels in the bile, leading to crystallisation and formation of pigment stones. The high bilirubin levels are due to the breakdown of red blood cells and hence occurring in individuals with red blood cell disorders like thalassemia, sickle cell anaemia and hereditary spherocytosis. Individuals with pigment stones tend to be much younger in their 20s to early 30s.

Most individuals with gallstones do not have symptoms. The gallstones are often incidentally diagnosed when the patient goes for an X-ray, ultrasound scan or CT scan for non-related problems.

Individuals who have symptomatic gallstones complain of a spectrum of symptoms that occur after taking food, and this can range from a mild discomfort to a bloated feeling to severe pain. These symptoms usually occur at the right upper quadrant or upper central region of the abdomen.

8-22% of individuals with initially non-symptomatic gallstones will go on to develop pain and/or complications in their lifetime. This occurs at a greater percentage in the first 5 years after the discovery of the gallstones.

There is a spectrum of gallstone-related complications, ranging from asymptomatic jaundice to acute cholecystitis (acute infection of the gallbladder) to cholangitis (acute infection of the bile duct) and acute necrotizing pancreatitis. These complications occur as a result of the gallstones causing obstruction/blockage to the flow of bile. Depending on the site of obstruction, the complications can range from acute cholecystitis (cystic duct obstruction) to cholangitis (bile duct obstruction) and pancreatitis (pancreatic duct obstruction).