TREATMENT OF GALL STONE DISEASE

Gall stone disease is a surgical condition and cannot be cured with medicines. But the decision to perform surgery will be made depending on the clinical situation of the patient. Once the diagnosis of gall stone disease is made, the first issue is to differentiate simple gall stone disease from gall stone disease with complications. To make a good treatment protocol, the clinical approach will be as follows. The various presentation of gall stone disease are,

SIMPLE GALL STONE DISEASE

1) Asymptomatic (without symptoms).

This category is the individuals with gall stone disease diagnosed incidentally by ultrasonography of abdomen done for some other reason or diagnosed during master health check-up.

The incidence of symptoms related to gall stones per year is about 1 to 3%. So young patients with gall stone diseases are encouraged to undergo surgical management to avoid future complications related to gall stone disease like obstructive jaundice due to bile duct stones and acute biliary pancreatitis due to bile duct stones.

The surgical management is to remove the gall bladder with stones. This can be done by laparoscopic technique (gall bladder removal by key hole surgery known as laparoscopic cholecystectomy) or open surgery known as open cholecystectomy in case of any technical issues like previous history of major upper abdominal surgeries.

2) Simple gall stone disease with co-morbid conditions

Here the individuals having gall stone disease without symptoms but with other co-morbid conditions like severe heart disease are better observed than submitting for surgery. The exception will be young patients with diabetes can have the surgery because of long standing diabetes may mask the symptoms of gall stone disease and ends up with complications. So young diabetic patients with associated gall stone disease can have elective laparoscopic cholecystectomy.

3) Patient undergoing surgery for other abdominal conditions can have the gall bladder removal surgery if the patient has associated asymptomatic gall stone disease.

4) Gall stone disease with kidney failure (CKD-chronic kidney disease)

Patients having gall stone disease with chronic kidney disease, who are going to undergo kidney transplant are candidates for elective cholecystectomy to prevent the development of cholecystitis as they are prone for cholecystitis because of long term immunosuppressant therapy.

5) Gall stone disease with associated other organ cancer patients who are the candidates for chemotherapy should also undergo gall bladder removal surgery to prevent the occurrence of cholecystitis during chemotherapy for cancer.

6) Gall stone disease with gall bladder polyps

Gall stone disease with gall bladder polyps requires gall bladder removal surgery as the patient is prone for gall bladder cancer formation.

7) Porcelain gall bladder

This condition needs prophylactic removal of gall bladder even in the absence of symptoms to prevent the development of gall bladder cancer in future.

8). Large gall stone

Gall stone size more than 1.5 cm requires prophylactic removal of gall bladder. These patients are at the high risk of developing gall bladder cancer in future.

 9) Bariatric surgery and gall bladder surgery.

Patients who are undergoing bariatric surgery, but has gall stone means should have gall bladder removal along with this bariatric surgical procedure. Otherwise because of rapid weight loss these patients develop acute calculus cholecystitis.

GALL STONE DISEASE WITH COMPLICATIONS

The common complications of gall stone disease are acute cholecystitis, chronic cholecystitis, acute gangrenous cholecystitis, gall bladder perforation, gall stone disease with jaundice, gall stone disease with biliary pancreatitis, gall stone disease with fistulas and Mirizzi’s syndrome will need gall bladder surgery. The surgery will be done after full evaluation and after treating associated conditions like jaundice or biliary pancreatitis.