They are structures that should not normally be present in the gallbladder, ranging from slimy precipitate (sludge) like a grain of sand to walnut size.
Cholesterol and pigment (bilirubin) stones appear in the gallbladder. The most common are cholesterol stones. Cholesterol in the body is excreted through the bile and from there to the intestine. In order for it to be excreted, this cholesterol must be present in liquid form.
This is achieved by lecithin and bile salts, which are contained in the appropriate proportions in the content of bile. The reason is not very clear why the ratios of the cholesterol-lecithin-bile salts trio in the bile are disturbed and the cholesterol begins to collapse by solidifying from the liquid state. This, in turn, forms the core of cholesterol stones.
Stones or stones in the gallbladder can remain for a lifetime without causing any problems, or they can cause life-threatening severe pancreatitis.
The approach varies according to whether the patient has stone-related problems.
If the patient has complaints such as stone-related pain, nausea, bloating, indigestion, surgical removal of the gallbladder is required (laparoscopic cholecystectomy). The pain is usually of a character that comes after meals and spreads from the right upper abdomen to the bottom of the shoulder.
If the patient has no complaints, the stone in the gallbladder is found only by chance, the treatment approach will be different. These stones are called 'silent gallstones'. When making a treatment plan in these patients, the age of the patient and the size of the stone are important. There is a risk that small stones (4-7 mm) will pass through the cystic duct and fall into the common bile duct.
Since the stone falling into the common bile duct has the potential to cause problems such as obstructive jaundice and acute pancreatitis, small stones are more dangerous than large stones. Silent stones detected at a young age are very likely to develop complaints in patients, considering the long years ahead of the patients.
In summary; patients with young age and small stones are recommended to have their gallbladder surgically removed, even if there are no clinical signs. In the opposite case, such as patients with older age and large stones, follow-up is recommended unless stone-related problems develop.
It is advantageous in terms of small incision sizes and short hospital stay. Almost all of them are completed closed. However, in some patients where the case is difficult, it can be started with open surgery from the beginning, or it has been started with the closed method and opened during the operation.
The gallbladder is taken as a whole. There is no such method as removing only the stone inside. Mostly, the surgery (cholecystectomy) is completed closed, that is, laparoscopically.
After the gallbladder is removed, the bile produced in the liver flows into the intestine in continuous drops. This can cause clinical pictures ranging from softening of the stool to the development of diarrhea in some people. This is called bile acid diarrhea and is usually temporary. Rarely, it requires drug treatment.
You haven't lost anything. The real question should be, 'Will I have trouble with this gallbladder that has stones in it?' A gallbladder that has started to form stones or sludge has the potential to do more harm than good. This risk also varies according to the age of the patient, the size and number of stones.
Some oral medications can dissolve the stones for a very long time. However, this does not solve the main problem, and since the cause of the formation of the stone does not disappear, it recurs. During this procedure, it is not a logical approach to increase the risk of the stones shrinking and falling from the gallbladder duct. We know that small stones are more dangerous than large stones. That's why surgery is the gold standard.
There is no scientific data that gallstones alone are the cause of cancer. However, there is also a claim that gallstones (especially those over 2 cm) pave the way for the development of cancer by creating a continuous friction effect on the sac wall and deterioration in the cells lining the sac wall from the inside as a result of recurrent inflammatory events.
If the gallbladder cannot be emptied due to gallstones or sludge, the sac wall becomes tense and edematous and the blood circulation in the wall is impaired. Bacteria cause inflammation in this favorable environment. In addition to pain, the patient also begins to complain of fever, and the gallbladder wall is found to be thickened on ultrasound. Additionally, CRP is increased due to inflammation.
The patient with complaints of pain and fever should be hospitalized, oral nutrition should be stopped, intravenous fluid supplementation, antibiotics and painkillers should be administered. Removal of the gallbladder at the same admission is the generally performed.
However, in cases where the duration is prolonged and the general condition of the patient is not suitable for surgery, the treatment of inflammation and the removal of the gallbladder 6 hf after the improvement of the general condition is also a way that can be chosen.
This condition is generally seen in intensive care patients who are not fed for a long time and whose general condition is impaired. Although it is tried to be suppressed with antibiotics, if the patient is suitable, the gallbladder should be removed.
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Prof. Dr. Sedat Karademir
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