The gallbladder is a thin walled bag that sits under the liver. It is a storage organ for the bile that is produced in the liver. The gallbladder contracts after a meal and squeezes the bile, a thick greenish liquid, through the bile duct, into the gut to help in the digestion of fats.

Gallstone disease is a very common medical problem in Asians. Gallstones are formed when chemical substances such as cholesterol, calcium and bile pigments crystallise in the bile. This process is aggravated if the gallbladder is diseased and not contracting normally. Gallstones may be in the form of sludge, gravel or even multiple hard stones up to several centimeters in size.

Women have double the risk of developing gallstones than men, mainly because of pregnancies. Lifestyle related risk factors that can be modified to prevent the formation of gallstones include obesity, smoking, lack of exercise, and a diet low in fibre and rich in saturated fats.

Gallstones are formed in the gallbladder, where they often remain asymptomatic (silent) for a long time. Some people later develop abdominal pain. This is a relatively strong pain typically located in the right side of the upper abdomen. The pain usually starts suddenly and lasts for over an hour. This pain may be associated with meals, especially after eating fatty foods.

After a number of years gallstones can cause troublesome complications. The gallbladder can become infected in a process called acute cholecystitis. The gallstones may move from the gallbladder into the bile ducts, causing obstruction and infection in the bile ducts, giving rise to fever and jaundice. If this stone is impacted near the pancreas, it can also lead to an inflammation of the pancreas called acute pancreatitis.

Symptoms suggestive of gallstones need to be investigated by your doctor. An ultrasonic scan can detect gallstones with a high degree of accuracy, and can also rule out other problems in the liver, pancreas and kidneys.

Asymptomatic gallstones do not require treatment, as the majority will never cause problems. Some may even disappear spontaneously.

Gallstones that cause pain are best treated by elective surgery. The gallstones are removed together with the gallbladder, as the gallbladder is usually diseased by then and would lead to recurrence of the gallstones if it is left behind. This operation is called a cholecystectomy, and it is usually done by a minimally invasive technique called laparoscopic surgery. In this procedure, long and thin instruments are used to perform the operation through small keyhole incisions. This operation is done under general anaesthesia but recovery is rapid and only an overnight hospitalization is required in most patients.

In some patients, for example those with previous abdominal surgeries, the laparoscopic approach is not suitable and a conventional operation is performed. Although the recovery period is slightly longer, this is also a safe operation.

Gallstones that have developed complications require urgent hospitalization and treatment. Any infection is treated by antibiotics and stones obstructing the bile ducts need to be removed through a scope (a procedure called endoscopic retrograde cholangio-pancreatogarphy, or ERCP) or by surgery.

Can gallstones be treated without surgery?

In selected patients with small stones made up of cholesterol, treatment by medication to dissolve the stones can sometimes be attempted. Some stones are also suitable for ultrasonic shock wave treatment. Nevertheless, these options are seldom used as treatment requires at least six months to a year, and the success rate is low. Gallstones also often recur after treatment is stopped.

What about traditional medicines such as Chinese herbal treatment?

None of these have been scientifically proven to be effective. By and large, they work like other forms of dissolution therapy and suffer from the same disadvantages (see 7.).

What is the success rate of gallbladder surgery? What problems will I have with my gallbladder removed?

The success rate for gallbladder surgery is very high. Most patients are cured of their symptoms. Very occasionally, residual or recurrent stones may form in the bile ducts. These can be treated by endoscopic removal, viz. ERCP.

Removal of a diseased gallbladder will not cause any harm to our body as the gallbladder is a non-essential organ. Some impairment of fat digestion may occur and patients are advised to restrict their intake of fatty foods in this case.