Can gallstones be removed without removing the gallbladder: Nonsurgical Treatment Options for Gallstones
Gallstones – NHS
Your treatment plan for gallstones depends on how the symptoms are affecting your daily life.
If you don’t have any symptoms, active monitoring is often recommended. This means you won’t receive immediate treatment, but you should let your GP know if you notice any symptoms.
As a general rule, the longer you go without symptoms, the less likely it is that your condition will get worse.
You may need treatment if you have a condition that increases your risk of developing complications, such as:
- scarring of the liver (cirrhosis)
- high blood pressure inside the liver (this is known as portal hypertension and is often a complication of alcohol-related liver disease)
Treatment may also be recommended if a scan shows high levels of calcium inside your gallbladder, as this can lead to gallbladder cancer in later life.
If you have episodes of abdominal pain (biliary colic), treatment depends on how the pain affects your daily activities.
If the pain is mild and infrequent, you may be prescribed painkillers to control further episodes and be given advice about eating a healthy diet to help control the pain.
If your symptoms are more severe and frequent, surgery to remove the gallbladder is usually recommended.
The gallbladder isn’t an essential organ and you can lead a normal life without one.
Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods trigger symptoms, you may wish to avoid them in the future.
Keyhole surgery to remove the gallbladder
If surgery is recommended, you’ll usually have keyhole surgery to remove your gallbladder. This is known as a laparoscopic cholecystectomy.
During a laparoscopic cholecystectomy, 3 or 4 small cuts are made in your abdomen.
One larger cut (about 2 to 3cm) is made by the belly button and the others (each 1cm or less) will be on the right side of your abdomen.
Your abdomen is temporarily inflated using carbon dioxide gas. This is harmless and makes it easier for the surgeon to see your organs.
A laparoscope (a long, thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in your abdomen.
This allows your surgeon to view the operation on a video monitor. They’ll remove your gallbladder using special surgical instruments.
If it’s thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation.
If gallstones are found, they may be removed during keyhole surgery. If the operation can’t be done this way, or an unexpected complication occurs, it may have to be converted to open surgery.
After the gallbladder has been removed, the gas in your abdomen escapes through the laparoscope and the cuts are closed with dissolvable stitches and covered with dressings.
Laparoscopic cholecystectomies are usually carried out under a general anaesthetic, which means you’ll be unconscious during the procedure and won’t feel any pain while it’s carried out.
The operation takes 60 to 90 minutes and you can usually go home the same day.
Full recovery typically takes around 10 days.
Single-incision keyhole surgery
Single-incision laparoscopic cholecystectomy is a newer type of keyhole surgery used to remove the gallbladder.
During this type of surgery, only 1 small cut is made, which means you’ll only have a single scar.
But as this type of cholecystectomy hasn’t been carried out as often as conventional cholecystectomies, there are still some uncertainties about it.
Access to single-incision laparoscopic cholecystectomies is also limited because it needs an experienced surgeon with specialist training.
Read more about single-incision laparoscopic cholecystectomy on the National Institute for Health and Care Excellence (NICE) website
A laparoscopic cholecystectomy may not be recommended if you:
- are in the third trimester (the last 3 months) of pregnancy
- are extremely overweight
- have an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous
In these circumstances, an open cholecystectomy may be recommended.
A 10 to 15cm (4 to 6in) incision is made in the abdomen, underneath the ribs, so the gallbladder can be removed.
General anaesthetic is used, so you’ll be unconscious and won’t feel any pain.
Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring.
Most people have to stay in hospital for up to 5 days. It typically takes 6 weeks to fully recover.
Read more about recovering from gallbladder surgery.
Endoscopic retrograde cholangio-pancreatography (ERCP)
Endoscopic retrograde cholangio-pancreatography (ERCP) is a procedure that can be used to remove gallstones from the bile duct.
The gallbladder isn’t removed during this procedure, so any stones in the gallbladder will remain unless they’re removed using other surgical techniques.
ERCP is similar to a diagnostic cholangiography (see diagnosing gallstones for more information), where an endoscope (a long, thin flexible tube with a camera at the end) is passed through your mouth down to where the bile duct opens into the small intestine.
But during ERCP, the opening of the bile duct is widened with a small cut or an electrically heated wire.
The bile duct stones are then removed or left to pass into your intestine and out of your body.
Sometimes a small tube called a stent is permanently placed in the bile duct to help the bile and stones pass.
ERCP is usually carried out under sedation, which means you’ll be conscious throughout the procedure but won’t experience any pain.
The procedure lasts about 30 minutes on average, but can take from 15 minutes to over an hour.
Afterwards, you may need to stay in hospital overnight so you can be monitored.
Medicine to dissolve gallstones
If your gallstones are small and don’t contain calcium, it may be possible to take ursodeoxycholic acid tablets to dissolve them.
But these aren’t prescribed very often because:
- they’re rarely very effective
- they need to be taken for a long time (up to 2 years)
- you can get gallstones again after treatment is stopped
Side effects of ursodeoxycholic acid are uncommon and are usually mild. The most commonly reported side effects are feeling sick, being sick and itchy skin.
Ursodeoxycholic acid isn’t usually recommended for pregnant or breastfeeding women.
Sexually active women should either use a barrier method of contraception, such as a condom, or a low-dose oestrogen contraceptive pill while taking ursodeoxycholic acid, as it may affect other types of oral contraceptive pills.
Ursodeoxycholic acid tablets may occasionally be used to prevent gallstones if it’s thought you’re at risk of developing them.
For example, ursodeoxycholic acid may be prescribed if you have recently had weight loss surgery, as rapid weight loss can cause gallstones to grow.
Diet and gallstones
In the past, people with gallstones who weren’t suitable for surgery were sometimes advised to adopt a very low-fat diet to stop the gallstones growing.
But recent evidence suggests this isn’t helpful because rapid weight loss resulting from a very low-fat diet can actually cause gallstones to grow.
This means that if surgery isn’t recommended or you want to avoid having an operation, it’s advisable to adopt a healthy, balanced diet based on The Eatwell Guide.
This involves eating a variety of foods, including moderate amounts of fat, and having regular meals.
A healthy diet won’t cure gallstones or completely eliminate your symptoms, but it can improve your general health and help control pain caused by gallstones.
Read more about healthy eating.
Page last reviewed: 19 November 2021
Next review due: 19 November 2024
Nonsurgical Treatment Options for Gallstones
Have you ever felt a strange aching pain in your upper abdomen? Usually digestive discomfort after a hearty meal isn’t anything to worry about, but for others, it’s a sign of a malfunctioning gallbladder.
Some people with gallstones never exhibit symptoms, while others experience severe pain. If you are experiencing pain in the upper abdomen or right side of the body, you may have gallstones, and will want to seek treatment to avoid further complications. At least in the United States, about 25 percent of newly diagnosed patients with gallstones will need treatment.
The gallbladder’s main function is to store bile, a substance secreted by the liver that helps with digestion. Sometimes bile contents crystallize and form gallstones.
Gallstones, which can be as small as a grain of salt or as large as a golf ball, can cause some serious problems. They can block ducts inside the organ, causing the gallbladder to become inflamed. Even worse, when a gallstone passes out of the gallbladder duct and into the main bile duct, it can lead to a bile duct infection that can ultimately cause inflammation of the pancreas.
Many patients have gallbladder surgery to alleviate pain and to avoid the potentially serious conditions caused by gallstones. In fact, surgery — in this case, a cholecystectomy, or gallbladder removal — is the most common form of treatment for gallstones. But the fact that surgically removing gallstones requires the removal of an entire organ has led to a growing interest in nonsurgical treatments for gallstones.
Why Treatment for Gallstones Is Necessary
Besides alleviating symptoms, treatment for gallstones is necessary to avoid a progression that can result in severe conditions, such as acute cholecystitis, the condition in which the gallstone blocks the gallbladder ducts, causing the gallbladder to become inflamed and infected. Patients with acute cholecystitis are usually hospitalized and receive antibiotics, pain medication, and often surgery.
If you do not have symptoms, the most common treatment is to “wait and see,” because the risks outweigh the benefits for both medical and surgical treatments. If you have gallbladder symptoms, surgical treatments are preferred unless you are at high risk, and then drug treatments may be utilized.
“If someone is symptomatic, we do recommend patients get the gallbladder taken out,” says Nikhil Kumta, MD, an attending gastroenterologist at Mount Sinai Hospital in New York City. “[Gallbladder surgery] is minimally invasive, so the risk of complications is low. But if people are unable to go through surgery, if someone is really old or really sick, there are different treatment options.”
Here are seven alternatives to surgery:
1. Thinning Bile With Acid Pills Can Dissolve Gallstones
In some cases, gallstones can be treated with medicine.
Certain chemicals, such as ursodiol or chenodiol, which have been shown to dissolve some gallstones, are available in oral bile acid pills. These medicines work by thinning the bile, which allows gallstones to dissolve.
While these pills can be effective and are generally well tolerated by patients, medical treatment of gallstones is limited to people whose stones are small and made of cholesterol. But according to Mount Sinai, these drugs can take two years or longer to work, and gallstones may return after treatment ends.
“Decreasing the cholesterol content of the bile can dissolve (certain gallstones), but it’s not effective enough that we don’t refer patients to surgery,” Dr. Kumta says.
2. Small Gallstones Can Be Broken Apart With Shock Waves
Another nonsurgical treatment for which gallstones must meet certain criteria is extracorporeal shock-wave lithotripsy (ECSWL). Although it is most commonly used to treat kidney stones, it can also be used on gallstones. The goal of the treatment is to break up, or fragment, gallstones by sending shock waves through the soft tissue of the body.
This method is only effective on solitary gallstones that are less than 2 centimeters in diameter, so fewer than 15 percent of patients are eligible for ECSWL. A case report published in 2017 in the International Journal of Surgery Case Reports found a low success rate for ECSWL patients with multiple gallstones. Even when stones are fragmented, a diseased gallbladder may not expel the fragment.
According to research published in the October-December 2014 issue of the Journal of Indian Association of Pediatric Surgeons, for this form of treatment, children may be the best candidates.
3. Gallstones Can Be Dissolved With an MTBE Injection
This nonsurgical treatment option involves injecting a solvent known as methyl tertiary-butyl ether (MTBE) into the gallbladder to dissolve the gallstones. According to research published in June 2015 in the journal Case Reports in Surgery, MTBE rapidly dissolves gallstones — but there can be some serious side effects, such as severe burning pain. MTBE creates fumes, and if it’s not administered properly in a ventilated area, it could cause severe burning for the patient and operators, and even cause electrical fires. Inquire about your doctor’s level of experience with performing this procedure before getting this form of treatment.
4. Endoscopic Drainage Follows the Gallbladder’s Natural Path
Endoscopic drainage mimics the healthy route of bile from the gallbladder to the small intestine. An endoscopic transpapillary treatment involves accessing the cystic duct with a camera through the mouth and down the throat. Then a wire is placed through the duct into the gallbladder. It is coiled to imitate the trajectory of the bile out of the small intestine, which is the same process as that of a healthy gallbladder. Kumta says that this form of treatment allows the gallbladder to resume normal bile disposal.
5. Percutaneous Cholecystostomy Is Best for Seriously Ill Patients
This is a nonsurgical treatment option, but it’s most effective when followed by gallbladder removal. Percutaneous cholecystostomy (PC) is typically saved for seriously ill patients who cannot tolerate surgery right away. The procedure involves using a needle to withdraw fluid from the gallbladder and then inserting a catheter through the skin to drain the fluid. The catheter is left in place for a number of weeks, after which gallbladder removal surgery is performed to prevent recurrence.
6. Transmural Drainage Decompresses a Swollen Gallbladder
“Transmural drainage creates a new tract directly through the stomach into the gallbladder,” Kumta says. An expandable metal stent is then placed to allow the gallbladder to drain into the small intestine. “This allows the gallbladder to decompress.”
With this approach, a study published in March 2016 in the journal Therapeutic Advances in Gastroenterology found high success rates, with one only 1 out of 16 patients experiencing complications during the stent placement process.
7. Acute Cholecystostomy, an Ultrasound-Guided Drainage Procedure
For patients who have acute cholecystitis or gallbladder inflammation and are unable to have surgery, an endoscopic stent can be placed between the gallbladder and alimentary tract to drain infection in a procedure called acute cholecystoenterostomy (ACE). A meta-analysis published in April 2018 in the journal Surgical Endoscopy found that ACE was just as effective, if not more effective, than percutaneous cholecystostomy in managing the pain and re-intervention rates of acute cholecystitis.
“Sometimes the surgeons will opt to do this before surgery when the gallbladder is inflamed. We give the patient antibiotics and drain the gallbladder so that it isn’t hot, sticky, and inflamed during surgery,” Kumta says.
When Considering Treatment Options, Talk to Your Doctor
As a gastroenterologist, Kumta always refers people to a surgeon if they are experiencing pain in their right abdomen, so that they can learn the pros and cons of removing the gallbladder.
Still, Kumta says that obesity is correlated with gallstone formation, and that patients can make dietary changes, lose weight if they are obese, and opt for a low-fat diet.
If you pick the change your diet, “wait and see” approach, be mindful of the factors that predispose someone to gallstones: You can’t control your age, your gender (women are more prone to gallstones), or your genes.
If you have gallstones, knowing what’s available to remove or otherwise treat them can help you in making your treatment decisions. Discuss these treatment options with your doctor and find the one that’s right for you.
Additional reporting by Calley Nelson
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City Clinical Hospital No. 31 im. Academician G.M. Savelyeva – Pills or surgery?
The surgical treatment of gallstones has long been recognized as the most effective and safest. However, many still doubt it.
What worries our readers the most?
Doctor of Medical Sciences, Head of the Department of Hospital Surgery of the Russian State Medical University, surgeon of the City Clinical Hospital No. 31 of Moscow, professor Sergey Georgievich Shapovalyants
1) Why remove the gallbladder if only one small stone has formed in it?
– Small stones in this case do not mean a small problem. On the contrary, they often cause serious complications.
If large formations lead to bedsores and gallbladder ruptures, then small stones are insidious in their own way. They can easily move and penetrate the bile ducts.
Wandering through them, the stones reach the duodenum. There, sooner or later, they get stuck, blocking the outflow of bile. Because of this, mechanical jaundice occurs.
Moreover, an attack of acute pancreatitis may suddenly develop. In this case, an ambulance from a doctor is needed.
Therefore, small stones should not be ignored. Even if at least one is found, you need to act. To date, the only treatment for gallstone disease is surgery – removal of the gallbladder.
2) There is a method of dissolving stones with the help of medicines. Why not try it before going to the surgeon?
– Indeed, there are such preparations. But the difficulty is that they rarely completely dissolve the stones. As a rule, drugs only slightly reduce them. The stone doesn’t go anywhere, it just gets smaller. Whether this is good or bad is a big question. As we said above, small stones cause no less problems than large ones.
Moreover, drugs are only effective against cholesterol stones. If they have a lot of calcium, conservative methods are useless.
One more thing. The size of the stones should not exceed 2 cm. It does not make sense to dissolve larger formations. This will take too long. After all, the stone, on average, decreases by no more than 1 mm per month.
It is not worth spending months or even years on this procedure. After all, no one can give a 100% guarantee of a successful result. And the risk of starting a problem is quite high.
Use with extreme caution in people with other gastrointestinal disorders. It is impossible to dissolve stones with stagnation of bile, acute inflammatory diseases of the gallbladder and bile ducts, liver diseases, stomach and duodenal ulcers, and problems with the intestines.
In addition, this seemingly harmless method of dealing with gallstones has its own side effects. The most common is stool disorder. And given that conservative treatment is designed for a long period, then it is unlikely that it will be possible to “endure” unpleasant reactions.
The situation is not easy. On the one hand, the method of drug dissolution of stones is quite safe – no anesthesia, incisions, postoperative rehabilitation is needed. On the other hand, it has many limitations and is not very effective.
3) How effective is the method of crushing gallstones, because kidney stones are crushed?
– The analogy between kidney stones and gallstones is often used. But these are completely different diseases, each of which manifests itself and is treated in its own way. Bringing them to the same denominator is incorrect.
At one time, the method of crushing gallstones using extracorporeal lithotripsy was widely used. During the session, multiple shock waves were directed at the stone from the outside. As a result, it was broken up into fragments, which then independently exited through the bile ducts and intestines.
In fact, not everything went so smoothly. Large fragments could not pass through the duct, so they remained in the gallbladder. Most of the small ones left “their place of residence”. But some of them got stuck in the bile ducts, clogged them and disrupted the process of bile formation. Therefore, after such a procedure, sometimes it was necessary to urgently do an operation.
There is one more important nuance. Usually gallstones are even, smooth, adapted to the shape of the gallbladder. Outside the attack, as a rule, they are not felt in any way. But after crushing, fragments are formed, which can cause colic and other painful sensations.
Due to the impressive number of undesirable consequences, this method is practically not used today. And in some foreign clinics, it is generally prohibited.
4) Is it possible to remove only stones and leave the gallbladder?
– It is possible, but this method is now recognized as ineffective. There is an opinion that some people, especially young people, should not have their gallbladder removed. After all, it performs important functions in the body.
Proponents of this approach perform an operation during which a small incision is made in the gallbladder. Through it, gallstones are taken out. Then the bladder is sutured, and after two or three days, a satisfied patient returns home. Without stones, and with a preserved gallbladder.
But not everything is so simple. Approximately 2-3 months after such an operation, the disease begins to bother again. The percentage of her return of the disease at different intervals reaches almost 100%. The fact is that one of the prerequisites for the formation of stones in the gallbladder is its poor contractility. Bile stagnates in it, from which stones are then formed.
Another reason is the individual characteristics of the bile itself. With any diet, even the lightest, it concentrates and precipitates. In this case, the elimination of stones alone simply does not make sense. Finally, the problem can be solved only by the complete removal of the gallbladder.
5) What are the advantages of laparoscopic stone removal?
– For a long time, gallstones were removed by the usual abdominal method. But today, many large hospitals and clinics are switching to a simpler and safer technique – laparoscopy.
The whole operation is carried out through three or four punctures in the abdominal wall. A miniature optical system is inserted through them. With its help, the abdominal cavity is examined, and then the gallbladder is removed with special tools.
As a rule, this is where the patient’s troubles end. After a short period of adaptation, he will be able to forget about gallstone disease forever.
Moreover, the absence of a gallbladder will be almost imperceptible. Indeed, in fact, his “biological loss” occurred much earlier – even at the stage of stone formation. Even then, the gallbladder stopped working normally, and other organs took over its “duties”.
6) Quite often, after removal of the gallbladder, a person feels even worse than before the operation. Maybe she doesn’t need it at all?
– There is such a thing as postcholecystectomy syndrome. This is a deterioration in well-being after removal of the gallbladder. Most often this happens if the operation is performed at an advanced stage of the disease, when neighboring organs are involved in the process.
In this situation, only one thing can be said – do not take things to extremes. Do the operation as planned, and not when the “thunder strikes.” Then problems can be easily avoided.
There is another reason – insufficiently serious preliminary examination. Today, removal of the gallbladder is considered a technically simple procedure for doctors and easily tolerated by patients. Therefore, the range of preliminary tests is often limited to one ultrasound of the abdominal cavity. And this is extremely small.
To get a complete picture and find out the true cause of poor health, it is necessary to carefully examine not only the gallbladder, but also all nearby organs. It is necessary to carefully assess the condition of the bile ducts, pancreas, duodenum, right kidney, stomach.
Not all medical institutions are equipped for this. Therefore, it is better to contact large clinics and centers.
When stones are suspected, endoscopic bile duct ultrasonography is now used successfully. It is performed using a miniature ultrasound probe or endoscope, at the end of which is an ultrasound probe. If there are stones in the bile ducts, you first need to eliminate them, and only then take on the gallbladder.
Computed tomography can help examine the liver and pancreas. Many of the necessary details will tell a biochemical blood test. Of course, not everyone needs these studies. But if there are at least some doubts, they cannot be ignored.
It is a thorough examination before surgery that allows you to choose the right tactics for treatment, preparation and recovery period. After all, the goal of surgical manipulations is not just to remove the problem, but to make it the most comfortable way for the patient.
ᐈ Treatment of gallstones without surgery
Methods for the treatment of stones in the gallbladder without surgery The development of pathology is due to a violation of the circulation of bile fatty acids between the liver and the gastrointestinal tract, associated with poor metabolism. These processes lead to the crystallization of bile, subsequent precipitation and the formation of stones.
In most cases, people are not aware of the presence of stones until an ultrasound scan or biliary colic attacks occur. When symptoms of the disease occur, patients are in no hurry to consult a doctor, because they are afraid of surgical intervention. We hasten to reassure you: modern medicine knows how to dissolve gallstones without surgery in a conservative way. In our article we will talk about the methods used and their features.
GSD may be asymptomatic or present with signs of biliary colic and acute cholecystitis. Patients who have an asymptomatic course of the disease and small calculi are detected should regularly undergo ultrasound and be observed by a gastroenterologist.
Removal of stones from the gallbladder without surgery is indicated in the following cases:
- No complications;
- Stones less than 2 cm in diameter;
- The duration of the calculus in the cavity of the gallbladder is not more than 2 years;
- The cavity of the gallbladder is filled with stones no more than 1/3.
To begin with, the specialist prescribes a diet that excludes spicy, fatty, fried and cholesterol-free foods, as well as alcohol and carbonated drinks. The menu includes only healthy products that are easily absorbed by the body. In case of exacerbation, the patient is shown a 3-day fast and subsequent fractional meals 5-6 times a day. It is advisable to eat according to the established schedule.
We are often asked whether it is possible to get rid of gallstones without surgery using drugs. Yes, the following medicines are used:
- Cholinolytics and antispasmodics to relieve duct spasm and free bile excretion;
- Ursodeoxycholic acid, stone-dissolving agent;
- With the development of cholecystitis – antibacterial agents with probiotics, enzymes and anthracites.