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Information for Patients:

Cholelithiasis Introduction   Cholelithiasis is the medical term that describes the presence of gallstones in the gallbladder (Fig. 1).

Gallstones are typically formed because of elevated levels of cholesterol in the bile, which is stored in the gallbladder. The liver secretes bile during meals to help with the absorption of fats. It may take years for gallstones to form. It is entirely random the shape and number that gallstones form. Some people have large stones and some have smaller and more numerable ones. Gallstone disease is very common; however, the majority of people who have them do not necessarily develop problems. Only 15%-20% of people who have gallstones develop complications such as biliary colic, cholecystitis, choledocholithiasis and pancreatitis. The gallbladder is found tucked up underneath the right side of the liver (Fig. 2).

Clinical Presentation Abdominal pain underneath the right rib cage that comes on after eating fatty, greasy meals that lasts for several hours is classic for gallstone related colic. If the pain persists for more than several hours and there is fever, then an infection called cholecystitis is a possibility. Normally, the cystic duct allows bile to drain out of the gallbladder. Pain occurs because a stone may be impacted in the cystic duct and bile is unable to be released causing a build up of pressure inside. The pain is relieved if the stone is able to dislodge itself. Impacted stones that are really stuck can lead to infections. If a stone escapes into the common bile duct, then jaundice, clay-coloured stools and dark tea coloured urine can occur. This condition is called choledocholithiasis. The diagnosis of gallstones is based on clinical presentation as well as the presence of gallstones on ultrasound or CT scan. Ultrasound is usually the first test because gallstones are demonstrated well. Blood work may demonstrate an elevated white cell count to indicate infection. An elevated bilirubin or abnormal liver tests may suggest choledocholithiasis.

Figure  1  Numerous  gallstones  are  found  within  this  gallbladder.

Figure  2  The  gallbladder  is  the  small  green  organ  underneath  the  liver.

 

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Information for Patients:

Cholelithiasis Treatment The treatment for symptomatic gallstones is laparoscopic cholecystectomy (Fig. 3). This procedure is done with small incisions and inserting a video camera into the abdominal cavity. Long, thin instruments are then used to find the gallbladder and to remove it. Occasionally, if there is severe inflammation, bleeding or any other difficulty, the laparoscopic approach may not be technically possible and the surgery is converted to the open technique. The benefits of the laparoscopic approach are that the recovery time from surgery is much faster and there is less pain. Patients typically arrive in the morning, have their surgery and are discharged later the same

day. If the open technique is done, patients may be required to be admitted to hospital for several days. There are rare occasions when the gallbladder is too inflamed to remove. If this is the case, a CT scan is done and a drain may be placed to resolve the infection. Once the inflammation has settled down, which may take several months, a repeat CT scan is done and elective surgery booked to remove the gallbladder. Follow-Up Laparoscopic cholecystectomy is a common procedure performed. It is usually day surgery with the patient arriving in the morning and then being discharged later on in the afternoon. All sutures used are hidden in the skin and will dissolve on its own. A follow-up appointment is made 4 weeks afterwards to review the pathology and to inspect the incisions.

Figure  3  Laparoscopic  cholecystectomy.