Treatment of Cholelithiasis

Medical

If the gallstones are mostly made from cholesterol, it may be possible to dissolve them using ursodeoxycholic acid. However, this method can only be used if the stones are relatively small, and it has to be continued for up to two years to work. Also, there is no guarantee that the stones will not form again after the treatment is over.

Extracorporeal shock wave lithotripsy is another non-invasive method which can be used to break down the stones if there aren’t too many of them and they are not too large. This is a non-invasive method that utilizes high-intensity, focused acoustic pulse in order to break the stones into tiny pieces. During the procedure the patient is anesthetized or sedated, and the lithotriptor is guided using ultrasound imaging system. The shockwaves cause direct shearing forces, and also cause cavitation bubbles to appear, which break down the stone into smaller pieces. The process lasts for about an hour.

This method has a lower chance of success than other more invasive methods, since not all stones can be broken down using this method. Lithotripsy is also used to break down kidney stones and stones that might appear in salivary glands.

Surgical

The least intrusive method of surgical treatment of gallstones is endoscopic retrograde sphincterotomy. This method involves using an endoscope to make incisions in the sphincter which is located right outside the gallbladder. This allows for smaller stones and bile to freely pass into small intestine. This method can be used only if the stones are not too large to pass through the biliary tract.

Another surgical method is cholecystectomy. During this operation the gallbladder is completely removed, which makes the bile pass directly from liver into the small intestine, without first being concentrated in the gallbladder. This causes 10-15% of the patients to develop postcholecystectomy syndrome which is characterized by persistent pain in right hypochondrium and gastrointestinal distress. Also, in 10% of the cases the patient may develop chronic diarrhea.

This procedure prevents recurrence of the cholelithiasis in 99% of the cases; however, cholecystectomy is only indicated in cases when the patient has symptoms of cholelithiasis. Asymptomatic patients are advised against going through this operation.

Cholecystectomy can be done using two surgical approaches:

• Open cholecystectomy – removal of the gallbladder through an abdominal incision below the lower right ribs. Hospitalization usually lasts for 3-5 days, and in a week the patient can return to normal diet. In several weeks the patient can return to normal activity.
• Laparoscopic cholecystectomy – was first introduced in the 80s. It is performed through 3 or 4 small puncture holes, through which a camera and instruments are inserted. After this operation the patient can be released from the hospital on the same day. For a few days the patient should stay at home and take pain medications. Within a week the patient can resume light activity and a normal diet. A slight pain in the place of operation and mild weakness can last for about 2 months after this procedure.

Currently, the laparoscopic cholecystectomy is the method of choice since it is much safer than open surgery and results in fewer complications associated with infection and adhesion. During the laparoscopy, there is no need to cut abdominal muscles, which results in less pain, faster healing, and good cosmetic results. However, in about 5% of the cases laparoscopic cholecystectomy cannot be performed due to gangrenous gallbladder, abdominal peritoneal adhesions, etc. In such cases, surgeons have to switch to standard cholecystectomy in order to remove the gallbladder safely.