KTPH Hepato–Pancreato–Biliary Surgery Service (HPB)

Gallstones and Biliary Tract Stones

• Gallstones in the gallbladder
• Gallstone in the mid common bile duct
• Gallstones in the distal common bile duct
• Gallstones in the neck of the gallbladder
• Intrahepatic biliary stones

Gallstones do not go away on their own. If the gallstones are not causing symptoms, watchful waiting is recommended. Patients with symptoms are more likely to experience future problems from gallstones. Medications to try to dissolve the gallstones are not very effective, and frequently have side effects: they are usually reserved for people who cannot undergo surgery. Electrohydraulic lithotripsy (shockwave therapy) is usually not effective and can injure organs nearby.

For medically fit patients, an operation to remove the gallbladder is the recommended treatment for gallbladder pain from gallstones (biliary colic, chronic cholecystitis) and is the definitive treatment for infection and inflammation of the gallbladder (acute cholecystitis). If there have been previous complications of gallstones, your doctor may also recommend removal of the gallbladder to prevent further problems happening again. Stones that have migrated deeper into the bile ducts will require additional procedures to clear the ducts before or during the removal of the gallbladder. The gallbladder is a non-essential organ and removing the stones alone without removing the gallbladder will not eliminate the risk of stones forming again.

If there has been a severe infection of the gallbladder, a course of antibiotics and sometimes a temporary external drainage procedure may allow the inflammation to improve so that removing the gallbladder is safer.

Complications of Gallstones and Biliary Tract Stones

Complications of gallstones may include:

• Inflammation from a gallstone blocking the neck of the gallbladder - severe pain, fever, infection of the gallbladder, breakdown and leakage of infected bile from the gallbladder wall
• Blockage of the common bile duct - severe pain, jaundice and bile duct infection with high fever, and liver abscesses can result
• Blockage of the pancreatic duct - inflammation of the pancreas with intense, constant abdominal pain, damage to surrounding organs from release of enzymes, usually require hospitalization. Very severe cases can cause damage to lungs, kidneys and other organ systems of the body
• Large gallstones >2-3cm have a slightly higher risk of gallbladder cancer, however the risk of risk is low and most people with gallstones never develop gallbladder cancer