The therapy of gallstones (biliary colic) is manifold. Gallstones that do not cause any symptoms do not require therapy. Gallstones that are particularly large are an exception.
If they exceed a critical size of 3 cm in diameter, it can be assumed that they will trigger symptoms and lead to gallstone disease in the foreseeable future. In this case, elective surgery, i.e. planned and not emergency surgery, is indicated. Chronic gallstone disease can trigger a so-called porcelain gall bladder due to the resulting recurrent inflammation.
The name is correct, since the gall bladder looks like porcelain due to its calcification in the ultrasound image. Since there is always the risk that a malignant tumor (carcinoma) will develop from this porcelain gall bladder, these patients are also advised to undergo surgery to treat gallstones. Gallstones that are symptomatic should be treated surgically.
In almost all cases, the entire gallbladder with the stones inside is removed. For this purpose, the so-called laparoscopic cholecystectomy is performed. The surgeon makes four small skin incisions into which surgical instruments are inserted.
Under camera view, the surgeon loosens the gallbladder and removes it through a previously inserted tube. If the patient belongs to a risk group (adhesions from previous operations or anatomical peculiarities), open removal of the gallbladder is considered. Instead of the small skin incisions, this therapy involves a longer incision in the right upper abdomen.
The surgeon operates under sight. Today, the laparoscopic surgical method has largely replaced the conventional open surgery. It is still used only in exceptional cases.
A colic (gallstone disease) can also be treated symptomatically. The patient is usually given painkillers (analgesics) and antispasmodic agents (e.g. butylscopolamine) during a 24-hour food withdrawal. However, an operation is recommended even after successful treatment of colic (gallstone disease).
If an inflammation of the gall bladder caused by gallstones is suspected, antibiotic therapy should be initiated. One treatment option, which is rarely used today, is the dissolution of the gallstone with medication. The therapy must be carried out for two years.
However, the success rate is only 70%. The disintegration of the gallstones by external shock waves is also used in rare cases. However, both of these alternative therapies require a certain stone composition. If there is a gallstone in the bile duct, the bile duct must first be slightly incised by the above-mentioned ERCP and finally the stuck gallstone must be rescued with a basket. Homeopathic approaches to therapy can also be found under Homeopathy for gallstones
