It is estimated that the gallbladder of every tenth German citizen fills with gallstones. Gallstones can cause painful bile colic. Then the gallbladder must be completely removed or, for stones in the bile ducts, the stone endoscopically removed from the bile duct, smashed or dissolved.
Stony gallbladder can hurt
The pear-shaped gallbladder is an appendage to the liver. It lies between the main trunk of the bile ducts, which lead out of the liver, and the bile duct, which flows into the duodenum. The task of the gallbladder is to store the bile produced by the liver for fat digestion. If necessary, the gallbladder wall contracts - nervally and hormonally controlled - and releases the bile fluid into the duodenum.
Gallstones' risk factors include a high-calorie, high-carbohydrate diet high in cholesterol and obesity, as well as fasting and radical diets. If no food is taken, the gallbladder does not empty regularly and the bile slowly thickens. Even a low-fiber diet is unfavorable, because more cholesterol is absorbed from the intestine.
When to remove the gallbladder?
Stones in the gallbladder, as well as those that have migrated into the bile ducts, can cause pain. A biliary colic, for example, occurs when a stone enters the bile ducts and causes the wall of the bile duct to contract convulsively.
If there are stones in the gallbladder and if a biliary colic has taken place for more than 15 minutes, the gallbladder must be removed by means of a minimally invasive gallbladder surgery (cholecystectomy). This is a minimally invasive, ie without abdominal incision, laparoscopic removal of the gallbladder. But do not worry, humans can live without a gallbladder.
Even if possible gallstones themselves do not cause any problems, the procedure is necessary if there are polyps in the gallbladder. They can lead to gallbladder cancer.
The gallbladder is also removed for gallstones that are already greater than three centimeters, or in a so-called porcine gallbladder with increased risk of cancer. A porcine gallbladder is present when the gallbladder wall is hardened as a result of chronic gallbladder inflammation. If the indication for surgery has been corrected, over 85 percent of operated patients benefit from the procedure.
Not always needed surgery
If ultrasonography randomly discovers gallstones or small gallstones that cause no pain, gallbladder surgery is not necessary. Who has gallstones and complains of complaints such as bloating, flatulence and pressure in the upper abdomen, but still had no biliary colic, it can first try after consultation with the doctor with low-dose ursodeoxycholic acid.
Ursodeoxycholic acid is a bile acid that has an anti-inflammatory effect on the gallbladder wall even at low doses, inhibits stone formation, promotes emptying of the bladder and promotes bile fluidity. Complaints such as upper abdominal pain and flatulence then occur less frequently.
When gallstones migrate in the bile ducts
Small stones often migrate from the bile ducts on their own if the mouth area of the bile duct in the duodenum is widened with a small incision. If larger stones are found in the bile ducts, they can be removed endoscopically using a kind of catching basket.
Gallstones can also be shattered by external shock waves (extracorporeal shockwave lithotripsy, ESWL for short). It is possible to "shoot" up to three stones at once. Precondition for the ESWL are free biliary tracts, so that the fragments can be excreted via the intestine. Pure cholesterol stones in the gallbladder less than five millimeters in size can also be dissolved by medication (litholysis). However, this process takes three months to two years and has a success rate of about 40 percent.
Gallstones often occur again after three to five years, especially after ESWL. However, those who change their diet to "lower fat and cholesterol" and reduce the weight, can prevent the formation of new. The enjoyment of coffee also seems to have a positive effect.