Overview: A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater. More than five lakh people go for a Gallbladder Surgery all across the world each year. Most of the patients are fine and their body adjusts fine to the dripping bile that their gallbladder once caught.
What is Gallstone?
Gallstones are solid lumps or stones that form in the gallbladder or bile duct. They are formed when some of the chemicals stored in the gallbladder harden into a mass. About one in three women and one in five men have gallstones by the age of 75. Some people get just one large stone; others may have lots of tiny ones.
What Causes Gallstone?
Scientists believe Gallstones form when bile contains too much cholesterol, too much Bilirubin, or not enough bile salts, or when the gallbladder does not empty completely or often enough. The reason these imbalances occur is not known. The cause of pigment stones is not fully understood. The stones tend to develop in people who have liver cirrhosis, biliary tract infections, or hereditary blood disorders—such as sickle cell anemia—in which the liver makes too much Bilirubin. The mere presence of gallstones may cause more gallstones to develop. Other factors that contribute to the formation of gallstones, particularly cholesterol stones, include
Sex: Women are twice as likely as men to develop gallstones. Excess estrogen from pregnancy, hormone replacement therapy, and birth control pills appears to increase cholesterol levels in bile and decrease gallbladder movement, which can lead to gallstones.
Family history: Gallstones often run in families, pointing to a possible genetic link.
Weight: A large clinical study showed that being even moderately overweight increases the risk for developing gallstones. The most likely reason is that the amount of bile salts in bile is reduced, resulting in more cholesterol. Increased cholesterol reduces gallbladder emptying. Obesity is a major risk factor for gallstones, especially in women.
Diet: Diets high in fat and cholesterol and low in fiber increase the risk of gallstones due to increased cholesterol in the bile and reduced gallbladder emptying.
Rapid weight loss: As the body metabolizes fat during prolonged fasting and rapid weight loss—such as “crash diets”—the liver secretes extra cholesterol into bile, which can cause gallstones. In addition, the gallbladder does not empty properly.
Age: People older than age 60 are more likely to develop gallstones than younger people. As people age, the body tends to secrete more cholesterol into bile.
Ethnicity: American Indians have a genetic predisposition to secrete high levels of cholesterol in bile. In fact, they have the highest rate of gallstones in the United States. The majority of American Indian men have gallstones by age 60. Among the Pima Indians of Arizona, 70 percent of women have gallstones by age 30. Mexican American men and women of all ages also have high rates of gallstones.
Cholesterol-lowering drugs: Drugs that lower cholesterol levels in the blood actually increase the amount of cholesterol secreted into bile. In turn, the risk of gallstones increases.
Diabetes: People with diabetes generally have high levels of fatty acids called triglycerides. These fatty acids may increase the risk of gallstones.
What are the Symptoms of Gallstone?
As gallstones move into the bile ducts and create blockage, pressure increases in the gallbladder and one or more symptoms may occur. Symptoms of blocked bile ducts are often called a gallbladder “attack” because they occur suddenly. Gallbladder attacks often follow fatty meals, and they may occur during the night. A typical attack can cause
Steady pain in the right upper abdomen that increases rapidly and lasts from 30 minutes to several hours
Pain in the back between the shoulder blades
Pain under the right shoulder
Notify your doctor if you think you have experienced a gallbladder attack. Although these attacks often pass as gallstones move, your gallbladder can become infected and rupture if a blockage remains.
People with any of the following symptoms should see a doctor immediately:
Prolonged pain, more than 5 hours
Nausea and vomiting
Fever, even low grade or chills
Yellowish color of the skin or whites of the eyes
Many people with Gallstones have no symptoms; these gallstones are called “silent stones.” They do not interfere with gallbladder, liver, or pancreas function and do not need treatment.
What is the Diagnosis of Gallstone?
Frequently, gallstones are discovered during tests for other health conditions. When gallstones are suspected to be the cause of symptoms, the doctor is likely to do an ultrasound exam—the most sensitive and specific test for gallstones. A handheld device, which a technician glides over the abdomen, sends sound waves toward the gallbladder. The sound waves bounce off the gallbladder, liver, and other organs, and their echoes make electrical impulses that create a picture of the gallbladder on a video monitor. If gallstones are present, the sound waves will bounce off them, too, showing their location. Other tests may also be performed.
Computerized tomography (CT) scans: The CT scan is a noninvasive x ray that produces cross-section images of the body. The test may show the gallstones or complications, such as infection and rupture of the gallbladder or bile ducts.
Cholescintigraphy (HIDA scan): The patient is injected with a small amount of non harmful radioactive material that is absorbed by the gallbladder, which is then stimulated to contract. The test is used to diagnose abnormal contraction of the gallbladder or obstruction of the bile ducts.
Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is used to locate and remove stones in the bile ducts. After lightly sedating you, the doctor inserts an endoscope a long, flexible, lighted tube with a camera down the throat and through the stomach and into the small intestine. The endoscope is connected to a computer and video monitor. The doctor guides the endoscope and injects a special dye that helps the bile ducts appear better on the monitor. The endoscope helps the doctor locate the affected bile duct and the gallstone. The stone is captured in a tiny basket and removed with the endoscope.
Blood tests: Blood tests may be performed to look for signs of infection, obstruction, pancreatitis, or jaundice.
Because gallstone symptoms may be similar to those of a heart attack, appendicitis, ulcers, irritable bowel syndrome, hiatal hernia, pancreatitis, and hepatitis, an accurate diagnosis is important.
How to Prepare for Gallstone Surgery?
Preparing for Gallstone Surgery can be stressful unlike other surgeries; however, following the tips given below can help you while you undergo the surgery.
Meet with a hospital staff member (usually a surgical nurse) to go over what to expect and anything specific they want you to do in preparation for surgery.
Speak with an anesthesiologist regarding what type and the amount of anesthesia being used. You must notify him of any allergies or negative reactions associated with anesthesia that you have encountered in the past. Discuss any concerns you have and decide on the best anesthesia plan.
Decide, with your doctor, if laparoscopic surgery is a suitable option versus traditional surgery. Patients who go the laparoscopic route usually recover more quickly and with less pain than with traditional surgery.
Fast beginning at midnight the night before surgery. This includes gum, coffee and candy.
Wash your stomach and abdominal area with antibacterial soap the night before or the morning of surgery to reduce the skin surface bacteria. Your doctor may give you a special pre-operative solution to use. Scrub the area well and rinse thoroughly.
Prevent attacks by refraining from spicy, fatty or rich foods. While these are not the only triggers, staying away from them will help prevent further pain.
Eat fiber-rich foods, as patients with gallstones often lack sufficient fiber in their diets. This helps keep your digestive system functioning properly.
What are the Common Procedures of Gallstone Surgery?
The following are the common procedures performed under Gallstone Surgery:
Cholecystectomy: Or removal of the gallstone surgically is the standard treatment for gallstones in the gallbladder. Surgery may be done through a large abdominal incision or laparoscopically through small punctures of the abdominal wall. Laparoscopic surgery results in less pain and a faster recovery. Cholecystectomy has a low rate of complications, but serious complications such as damage to the bile ducts and leakage of bile occasionally occur. There also is risk associated with the general anesthesia that is necessary for either type of surgery. Problems following removal of the gallbladder are few. Digestion is not affected, and no change in diet is necessary. Chronic diarrhea occurs in approximately 10% of patients. And if the gallbladder is extremely diseased (inflamed, infected, or has large gallstones), the abdominal approach (open cholecystectomy) is recommended. This surgery is usually performed with an incision in the upper midline of the abdomen or on the right side of the abdomen below the rib (right subcostal incision). If a stone is lodged in the bile ducts, additional surgery must be done to remove it. After surgery, the surgeon will ordinarily insert a drain to collect bile until the system is healed.
Sphincterotomy: This procedure involves cutting the muscle of the common bile duct (sphincter) at the junction of the common bile duct and the duodenum in order to allow easier access to the common bile duct. The cutting is done with an electrosurgical instrument passed through the same type of endoscope that is used for ERCP. After the sphincter is cut, instruments may be passed through the endoscope and up into the hepatic and common bile ducts to grab and pull out the gallstone or to crush the gallstone. It also is possible to pass a lithotripsy instrument that uses high frequency sound waves to break up the gallstone. Complications of sphincterotomy and extraction of gallstones include the general anesthesia, perforation of the bile ducts or duodenum, bleeding, and pancreatitis. The operation takes about 20 to 30 minutes. The wound is then sutured closed, usually with stitches that dissolve in time. Most patients can go home the same day. Once the surgery is completed, you will be taken to a post-operative or recovery unit. Your length of stay will depend on the complexity of the procedure. Most patients return home on the same day. Your doctor will explain the procedure for post-operative care. This will involve keeping the operated area clean and dry, eating a high fiber diet, drinking plenty of fluids, and using stools softeners.
Extracorporeal Shock Wave Lithotripsy: is a treatment in which shock waves are generated in water by lithotripters (devices that produce the waves). There are several types of lithotripters available for gallbladder removal. One specific lithotripter involves the use of piezoelectric crystals, which allow the shock waves to be accurately focused on a small area to disrupt a stone. This procedure does not generally require analgesia (or anesthesia). Damage to the gallbladder and associated structures (such as the cystic duct) must be present for stone removal after the shock waves break up the stone. Typically, repeated shock wave treatments are necessary to completely remove gallstones. The success rate of the fragmentation of the gallstone and urinary clearance is inversely proportional to stone size and number: patients with a small solitary stone have the best outcome, with high rates of stone clearance (95% are cleared within 12–18 months), while patients with multiple stones are at risk for poor clearance rates. Complications of shock wave lithotripsy include inflammation of the pancreas (pancreatitis) and acute cholecystitis.
Dissolution of Gallstone Removal: A method called contact dissolution of gallstone removal involves direct entry (via a percutaneous transhepatic catheter) of a chemical solvent (such as methyl tertiary-butyl ether, MTBE). MTBE is rapidly removed unchanged from the body via the respiratory system (exhaled air). Side effects in persons receiving contact dissolution therapy include foul-smelling breath, dyspnea (difficulty breathing), vomiting, and drowsiness. Treatment with MTBE can be successful in treating cholesterol gallstones regardless of the number and size of stones. Studies indicate that the success rate for dissolution is well over 95% in persons who receive direct chemical infusions that can last five to 12 hours. Current research indicates that the success rate for oral dissolution treatment is 70–80% with floating stones (those predominantly composed of cholesterol). Approximately 10–20% of patients who receive medication-induced litholysis can have a recurrence within the first two or three years after treatment completion.
What is the Post-Operative Care after Gallstone Surgery?
Here are tips and Post-Operative care that the patients need to observe after having the Gallstone surgery:
Eat foods that are low in fat such as those high in omega 6 and omega 3. Use only unprocessed vegetable oils such as olive oil and should not be used in cooking but as salad dressings.
Dairy products should only be consumed one month after surgery.
Vegetables like tomatoes, celery, carrots, sweet potatoes, cucumber, okra, garlic and onion, and vegetable juice are all included.
Eat some lemon, grapes, and apples.
Grilled chicken and skinned fish is also an option.
Aftercare for gallbladder removal should include processed water (boiled or filtered).
Do not eat eggs, oranges, margarine, friend foods, foods with artificial flavoring and preservatives, coffee, alcoholic beverages, chocolates, cabbage, carbonated drinks, wheat, rye, and legumes.
Have short light meals and increase drinking fluids. Do not completely stop consuming fatty foods instead gradually increase the intake. It is important to consult your dietician.
What is the Recovery after Gallstone Surgery? Once the incisions are closed, the patient is allowed to slowly wake, and the breathing tube is removed. The patient is then transported to the Post-Anesthesia Care Unit for monitoring while the anesthesia drugs completely wear off. During this phase of recovery, the patient will be closely watched by the staff for signs of pain, changes in vital signs or any complications from surgery. If no complications are observed and the patient is awake, they can be transferred to a hospital room an hour or two of surgery. Most patients are able to go home within twenty four hours of surgery to continue recovering from surgery and return to their normal daily activities in less than a week. More strenuous activity may require longer healing time. A small percentage of patients require a low fat, high fiber diet in the first few weeks after surgery to prevent discomfort and diarrhea after eating. If diarrhea persists despite dietary changes, the surgeon should be notified. The surgical incisions require minimal care and can be cleaned with soap and water during a shower. If the incision was closed with adhesive bandages, they will fall off on their own, or can be removed by the surgeon during an office visit like staples and stitches. Any foul drainage or significant redness of the incisions should be reported.
Why Gallstone Surgery in India?
India has emerged to be a new pioneer in providing a cost effective Gallstone Surgery and other medical treatments. Thousands of international patients from all across the world fly to India for various medical treatments and surgeries of high quality delivered as practiced in the developed nations like the US, UK and that too within their budget costs.
The Indian medical professionals performing different procedures of Gallstone Surgery in India are highly qualified, skilled with many years of experience and are affiliated with many renowned medical institutions. India provides the services through most leading doctors and Urosurgeons.
The Gallstone Surgery Hospitals in India are well equipped with the most advanced medical treatment and methodologies. They have the most extensive diagnostic and imaging facilities including Asia’s most advanced MRI and CT technology. These are available in the following cities at reasonable costs in the following cities:
What is the Cost of Gallstone Surgery in India?
India offers the most incredible cost saving Gallstone Surgery, which goes to around 80% less than prevailing USA or UK rates. Even with travel expenses taken into account, the comprehensive medical tourism packages still provide a savings measured in the thousands of dollars for major procedures. A cost comparison of various medical treatments can give you the exact idea about the difference:
Procedure Cost (US$)
Some of the common countries from which patients travel to India for surgery are:
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