Whether one should remove gallstones or not, depends among other things on any complaints and the location of the stones. Read here, when to remove gallstones, which methods exist and how they work!
Gallstones in the bile duct
In the case of “silent” gallstones in the bile duct, the doctor and the patient must carefully weigh the individual benefit and the risk of treatment – and then decide whether removal is necessary or not. Sometimes it’s just a wait-and-see, as bile duct stones can go away on their own. If this does not happen or if the bile duct stones cause discomfort, they are usually removed by endoscopy: within the framework of the so-called Endoscopic retrograde cholangiopancreatography (ERCP), which also serves to diagnose the bile duct stones, the stones are removed using special wire loops.
Gallstones in the gallbladder
“Dumb” gallstones in the gallbladder usually do not need to be treated. For example, a rare exception is gallbladder stones larger than three centimeters in diameter because they increase the risk of gall bladder cancer.
Also necessary is a treatment when gallbladder stones cause discomfort (symptomatic gallstones): treatment of choice here is the surgical removal of the gallbladder (gallstone surgery). There are also alternative methods (dissolve or smash gallstones); but these are rarely used.
Gallstones: surgery
In gallstone surgery, the entire gallbladder, including the stones in it, is removed (cholecystectomy). Only in this way can biliary colic be permanently avoided.
Nowadays, the gall bladder is rarely removed via a large abdominal incision (open surgery), such as in abdominal complications or adhesions. In most cases, gallstones today are operated via one laparoscopy (Laparoscopy): Under general anesthesia, three to four small incisions are made in the abdominal wall. These are used to insert the surgical instruments and remove the gallbladder. After such a laparoscopic cholecystectomy, patients usually recover faster than after an open surgery and can leave the clinic earlier.
Meanwhile, there are other variants of the laparoscopic surgical technique. The surgical instruments are inserted through the vagina, stomach or navel into the abdomen. At present it is not possible to say how safe and beneficial these surgical variants are in comparison to conventional laparoscopy.
Dissolve gallstones (litholysis)
In some cases it is possible to dissolve gallstones with the help of the active substance UDCA (ursodeoxycholic acid). The active ingredient-containing tablets but must be taken over a longer period (sometimes over two years). However, the treatment with gallstones only leads to success in some of the patients. In addition, new gallstones often form rapidly after weaning of the tablets. Therefore, the litholysis is attempted only in isolated cases, for example in gallstones, which cause only mild discomfort and / or rare colic.
Gallstones smash
With the help of shock waves, some gallstones can be smashed: the patient lies in a water bath and the gallstones are bombarded with shock waves. The resulting debris can then leave the body naturally (via the intestine). The procedure will Extracorporeal shockwave lithotripsy (ESWL) called and was originally developed for kidney stones. It is rarely used to remove gallstones because the rate of recurrence (relapse rate) is quite high: in the majority of patients, new gallstones are formed after treatment, so that surgical removal of the gallbladder is ultimately necessary. The ESWL is therefore, according to experts, not a good practice, if one Remove gallstones want.