Cholelithiasis: should I have surgery or not?

The first warning signs are heaviness in the right hypochondrium, bitterness in the mouth and nausea after eating, which are common signs of biliary tract diseases. Often, a person does not suspect the existence of gallstones until they are detected by ultrasound of the abdominal organs, and in the worst case, when biliary colic and other symptoms develop due to stones from the gallbladder entering the common bile duct and its blockage. 

Biliary colic is pain in the right hypochondrium or "pit of the stomach" in the epigastric region caused by the contraction of the walls of the gallbladder, which tends to push out the "plug" that clogs it. The intensity of the pain increases, then the pain becomes constant (up to several hours), after which it gradually decreases and disappears when the movable stone returns to the gallbladder cavity. There is no pain between attacks. But if the stone remains in the bile duct, complications such as acute cholecystitis, mechanical jaundice, perforation of the gallbladder and the development of peritonitis may develop, which require emergency surgical care. 

Patients suffering from gallstone disease are divided into two groups: patients with symptoms of biliary colic and a picture of acute cholecystitis, and patients who do not have stones. 

Currently, the vast majority of surgeons agree that patients with asymptomatic cholelithiasis with a small stone found for the first time should not immediately undergo preventive cholecystectomy (removal of the gallbladder). The risk of developing severe complications with small single stones is assessed as low, therefore, such patients should regularly undergo ultrasound examinations of the abdominal cavity and follow the recommendations on lifestyle and nutrition. 

The long—term presence of stones is always accompanied by the addition of a secondary infection and the development of chronic cholecystitis, which leads to various diseases of neighboring organs - the liver and pancreas. Long-term inflammation also increases the risk of developing gallbladder cancer. Therefore, the doctors of the EMC Surgical Clinic recommend that after observing asymptomatic stones for 2 years, nevertheless consult a surgeon. In some concomitant diseases (for example, diabetes mellitus), with large stone sizes, and with pathological changes in the gallbladder itself, the doctor may recommend removing the gallbladder during the "quiet period" of the disease after a comprehensive examination and preparation of the patient. 

In the case of calculous cholecystitis, when the patient is periodically disturbed by attacks of biliary colic, surgeons recommend cholecystectomy, which should be performed as planned. Each subsequent attack can cause the development of acute cholecystitis, which, as already noted, can be accompanied by severe complications from the liver and pancreas. If a picture of acute cholecystitis develops — biliary colic lasts for more than 3 hours, the pain is localized in the upper right quadrant of the abdomen, does not relieve with antispasmodic drugs, fever rises, nausea and vomiting occur - an ambulance should be called. 

Doctors at the EMC Surgical Clinic are ready to perform surgery for calculous cholecystitis around the clock using laparoscopic access, the least traumatic and safest method. Regardless of how many stones are found in the gallbladder – one large or many small — the gallbladder is completely removed. There are contraindications to laparoscopic cholecystectomy – in this case, the surgeon may decide to perform an open, laparotomy operation. 

A pathologically altered gallbladder cannot fully perform its functions, and is the cause of constant pain and a source of chronic infection. Therefore, cholecystectomy performed in accordance with the indications of a qualified doctor improves the patient's condition and does not affect the digestive function.