Diagnosis and Treatment of Gallstones

How are Gallstones Diagnosed?

Most people with gallstones have what are called silent stones; they have no symptoms. Many times gallstones are detected during an abdominal x-ray, computerized axial tomography (CT) scan, or abdominal ultrasound that has been taken for an unrelated problem or complaint. But steady severe pain in the upper abdomen which may be accompanied by nausea or vomiting, pain between the shoulder blades, or in the right shoulder, are symptoms of a gallstone attack.

When actually looking for gallstones, the most common diagnostic tool is ultrasound. An ultrasound examination uses sound waves. Pulses of sound waves are sent into the abdomen to create an image of the gallbladder. If stones are present, the sound waves will bounce off the stones, revealing their location. Ultrasound is a painless noninvasive technique, which means nothing is injected into or penetrates the body. No radiation is involved.

How are Gallstones Treated?

Gallbladder surgery, or cholecystectomy, is the most common method for treating gallstones. Each year more than 500,000 Americans have gallbladder surgery. Surgery options include the standard procedure, called open cholecystectomy, and a less invasive procedure, called laparoscopic cholecystectomy.

The standard cholecystectomy is a major abdominal surgery in which the surgeon removes the gallbladder through a 5- to 8-inch incision. Patients may remain in the hospital about a week and may require several additional weeks to recover at home.

Laparoscopic Cholecystectomy

Laparoscopic cholecystectomy has replaced open cholecystectomy as the first-choice of treatment for gallstones, unless there are contraindications against the laparoscopic approach. Abdominal adhesions and other problems that obscure the surgeon's vision are discovered during about 5% of laparoscopic surgeries, forcing surgeons to switch to the standard cholecystectomy for safe removal of the gallbladder.

Laparoscopic cholecystectomy requires several small incisions in the abdomen to allow the insertion of surgical instruments and a small video camera. The camera sends a magnified image from inside the body to a video monitor, giving the surgeon a close-up view of the organs and tissues. The surgeon watches the monitor and performs the operation by manipulating the surgical instruments through separate small incisions. The gallbladder is identified and carefully separated from the liver and other structures. Finally, the cystic duct is cut and the gallbladder removed through one of the small incisions.

Laparoscopic cholecystectomy does not require the abdominal muscles to be cut, resulting in less pain, quicker healing, improved cosmetic results, and fewer complications such as infection. Recovery is usually only a night in the hospital and several days of recuperation at home.

Alternatives to Gallbladder Surgery

Nonsurgical approaches are used only in special situations, and only for gallstones that are predominantly cholesterol. Oral dissolution therapy with ursodiol (Actigall) and chenodiol (Chenix) works best for small, cholesterol gallstones. These medicines are made from the acid naturally found in bile. They most often are used in individuals who cannot tolerate surgery. Treatment may be required for months or years before gallstones are dissolved, and the drugs do have side effects. The alternatives to gallbladder surgery leave the gallbladder intact; so stone recurrence, which happens in about half of the cases, is a major drawback.

Information provided by the
National Institutes of Health

For more information see: Causes and Symptoms of Gallstones.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.