What are Gallstones and how are they formed?
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.
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What are the symptoms of Gallstones?
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.
What are the complications associated with Gallstones?
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).
Other FAQs on Gallstones
A gallbladder removal surgery (cholecystectomy) is strongly recommended if the patient has symptoms resulting from gallstones or if there is any history of any gallstone-related complications.
A gastroscopy (OGD) is essential as part of the workup leading to a cholecystectomy. This is to ensure that gastric-related symptoms, which can resemble gallstone-related symptoms, are eliminated as possible causes.
The majority (over three-quarters) of cholecystectomies are performed as keyhole (laparoscopic) surgeries. Laparoscopic surgery offers the advantage of smaller wounds and less physiological stress on the body, resulting in shorter hospital stay, decreased post-operative pain and much lower wound infection rates.
The operative procedure involves four small incisions (wounds) on the abdomen. The incision at the belly button is about 1.5cm in length, with the other incisions at 5-8mm in length. The surgery and subsequent retrieval of the gallbladder are all carried out through these four incisions. The surgery entails the removal of the entire gallbladder together with the gallstones contained within it. The connection between the gallbladder and the common bile duct, known as the cystic duct, will be securely closed off with two surgical clips. The gallbladder will not regrow back after the surgery.
Contrary to popular belief, there are minimal health consequences related to the gallbladder being removed. A minority of patients (20-30%) may have some watery or loose stools after an oily meal. Thankfully, these symptoms usually last for 1-2 weeks and are rarely permanent. The digestive function of fats/lipids will return to normal within a very short time.