Gallstones in the bile duct
In the case of “silent” gallstones in the bile duct, the physician and patient should decide together whether or not removal is necessary or advisable – after considering the individual benefits and possible risks of treatment. Sometimes it is simply a case of waiting, as bile duct stones can also go away on their own.
If the bile duct stones cause discomfort, they are usually removed by endoscopic means: in the course of so-called endoscopic retrograde cholangiopancreaticography (ERCP), which is also used to diagnose bile duct stones, a doctor removes the stones with the help of special wire loops. In the case of larger stones, it may first be necessary to break up the stones mechanically (mechanical lithotripsy) or to dilate the bile duct using a small balloon inflated in situ (endoscopic balloon dilatation). Both can be done during ERCP.
If patients who have failed removal of bile duct stones by ERCP also have gallbladder stones, surgical intervention should be considered.
Gallstones in the gallbladder
“Silent” gallstones in the gallbladder usually do not require treatment. Exceptions include very large gallbladder stones (diameter > 3 cm) – in this case, treatment should be considered because these large stones increase the risk of gallbladder cancer. For the same reason, treatment is usually recommended for the very rare “porcelain gallbladder” (removal of the gallbladder), even if it does not cause any symptoms. A porcelain gallbladder can develop when gallbladder stones cause chronic gallbladder inflammation. Certain forms of this complication significantly increase the risk of gallbladder cancer.
Gallstones: Surgery
During gallstone surgery, the entire gallbladder is removed (cholecystectomy) – including the stones inside. This is the only way to permanently avoid biliary colic and complications.
Nowadays, the gallbladder is rarely removed via a large abdominal incision (open surgery), for example in the case of complications or adhesions in the abdominal cavity. Instead, gallstone surgery today is usually performed via laparoscopy: In the conventional method, the surgeon makes three to four small incisions in the abdominal wall of the patient (under general anesthesia). Through these, he inserts the surgical instruments and removes the gallbladder. After this laparoscopic cholecystectomy, patients usually recover more quickly than after open surgery and can leave the hospital sooner.
Meanwhile, there are also other variants of laparoscopic cholecystectomy. Here, the surgical instruments are introduced into the abdominal cavity either through a single incision in the area of the belly button (single-port technique) or through natural orifices such as the vagina (NOTES = Natural Orifices Transluminal Endoscopic Surgery).
Dissolving gallstones (litholysis)
The disadvantages of this medicinal gallstone treatment: The tablets must be taken over a longer period of time (several months). The treatment is successful in only some of the patients. In addition, new gallstones often form rapidly after discontinuation of the tablets. Therefore, UDCA should only be used to remove gallstones that cause only mild discomfort and/or rarely cause colic.
