Q. What is a gall stone?
A. It is made up of a combination of Calcium, Bile and Cholesterol. A gallstone is a stone formed in the gall bladder, which is a sac in which the bile is usually stored. You may have one large stone or hundreds of small stones in your gall bladder.
Q. Why is the gall stone not seen on plain X-ray of the abdomen as is the kidney stone?
A. Any stone which contains calcium is seen on plain X-ray. If there is no calcium in the stone, the stone cannot be seen on a plain X-ray. Only 8-10 percent of gall stones contain calcium (where as 90 % kidney stones contain calcium), that is why we have to use special tests like ultra-sonography to diagnose gallstones.
Q. What is the cause of the gall stones?
A. The exact cause of gall stones is not yet clear but we know some facts which are very important.
* Gall stones is the disease of the civilized world. It is more common in western countries.
* It is more common in the affluent community than the poor community.
* It is more common in women of the child-bearing age. More the pregnancies in quick succession, more the chances of developing gall stones.
* It is more common in people who take a diet rich in fried foods, ghee, butter, milk products like cheese, chocolates etc.
* It is more common in people who are overweight and who take no physical exercise.
* It is common in the forties, fifties and sixties. Though the youngest patient in our experience was 4 years of age, this is an exception rather than a rule.
Q. What is the treatment for the gall stones?
A. The only reliable and permanent treatment for gall stones is an operation, in which the entire gallbladder is removed along with the stones.
Q. Do you remove only the gall stones or the whole of gall bladder?
A. it is very tempting to remove only the gallstones and to keep the gall bladder intact. But experience has shown that the gall stones can form again. This is so because the gall bladder has become diseased. Therefore it is the standard surgical practice all over the world to remove the gall bladder. There is also a small risk of cancer developing in the diseased gall bladder.
Q. If you remove the gall bladder what happens to the normal function of the gall bladder?
A. World-wide experience has shown that removal of gall bladder does not cause any problems of digestion to the patient after the operation. The common bile duct takes over the storage function to some extent and therefore there are no side effects post-operatively. You will be able to lead a completely normal life, without any restrictions of the diet.
Q. What is the operative procedure?
A. Laparoscopic removal of gallbladder has revolutionized gall bladder surgery since 1990. This technique is successful in 97-98% of patients in the hands of an expert surgeon. Instead of making a large cut on the abdomen, the technique involves making 4-5 small (5-10mm) punctures on the abdominal wall under full anaesthesiA. A thin telescope with camera is introduced in the abdominal cavity and the gall bladder is removed with the help of various specialized instruments.
As the punctures are very small the post-operative discomfort is minimal. The patient is allowed to walk after 4-6 hrs, can take normal food the next day & can go home within 24-48 hrs. Full recovery takes 5-7 days. Open operation may be required in some 1-2% of cases. Thick-walled and contracted gall bladder, perforation of gall bladder with localized peritonitis, large stone impacted at the junction of cystic duct and common bile duct, are some of the reasons for converting the laparoscopic operation to open surgery.
Q. Is it a ‘Major’ operation?
A. Removal of a gall bladder is not as minor an operation as a hernia or hydrocoele operation, but there is definitely no risk to life. With the developments in anaesthesia and laparoscopic surgery, there is no risk to life during the operation in expert hands.
Q. Is there a way of dissolving the stones without the operation?
A. There are drugs which can dissolve the stones without any operation but they cannot be used in all patients because of the following reasons:
* These drugs can dissolve only those stones which are small and which do not contain any calcium.
* The drugs have to be taken continuously for 3-4 years before the stones can be dissolved.
* If the drugs are stopped, the stones usually form again, so they may have to be taken for a very long time.
* These drugs can damage the liver.
For these reasons such drugs are not used routinely, on patients. Operation is a much quicker, surer and safer method of relieving you of your gall stones.
Q. What will happen if the operation is not done?
A. The gall bladder has a narrow duct which joins it to the bile duct. The stone can block this duct and cause severe pain. This blockage leads to inflammation of gall bladder. If the pressure inside the gall bladder rises too much, it can rupture and can lead to peritonitis. The stone can slip down in the bile duct and can block it where it enters the duodenum. This prevents the bile from entering the intestine. This bile then mixes in the blood and jaundice results. Gall stone in bile duct can also cause inflammation of the pancreas with its serious complications. This is the reason why we advise you to undergo an operation as early as possible.
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