Doctors for Gallstones in Gangtok

Gallstones, also known as gallbladder stones, are solid pebble-like accumulation of bile material inside the gallbladder. The gallbladder is a small organ found under the liver. It is responsible for storing and releasing bile produced by the liver to digest fats.

The size of gallstones can vary from a tiny sand-like particle to large stone-like pebbles. These stones are made up of cholesterol, bilirubin, or a composition of both. Bilirubin is a waste material that forms because of the breakdown of red blood cells.

Generally, gallstones do not show any symptoms in most people, but they are capable of leading to a lot of health issues. Sometimes, these stones block or obstruct the bile ducts, responsible for carrying bile from the gallbladder to the small intestine, which leads to severe abdominal pain. Gallbladder stone pain is also known as a gallbladder attack.

Mainly, there are two types of gallstones. The classification of the two types is mainly based on their composition:

• Cholesterol Stones: Accounting for about 80-85% of all cases, cholesterol stones are the most common type of gallbladder stones. These stones mainly consist of cholesterol, which is a fatty substance present in the bile. Apart from being different in size, these stones can vary in colours too. They can range from yellowish to greenish. This type of stones develops in the gallbladder when there is an imbalance in the components of bile, which leads to excess cholesterol and reduced bile salts and lecithin, a type of fat.
• Bilirubin or Pigment Stones: As already discussed, pigment stones are made of bilirubin, a waste pigment formed due to the breakdown of red blood cells. The presence of calcium salts in the bile adds to the formation of these stones. Unlike cholesterol stones, bilirubin stones are typically smaller in size and darker in colour. Pigment stones generally form when there is excess quantity of bilirubin in the bile or when the bile does not contain enough bile salts to keep bilirubin in a soluble form.

Generally, doctors perform a physical examination and ask you about your medical history, eating habits and family history of gallbladder stones, before moving ahead with any imaging or diagnostic tests. Here are some of the most common tests performed to diagnose gallstones:

• Abdominal Ultrasound: This is the most common test for diagnosing gallbladder stones. This method uses a device called a transducer, which is moved back and forth on the abdominal region. This device emits signals to a computer which prepares images showing the internal structures of your abdomen.
• Endoscopic Ultrasound (EUS): This procedure is used to trace any small gallbladder stones that could not be seen in the abdominal ultrasound. In this procedure, a thin tube called endoscope is passed through the mouth and digestive tract of the patient. This tube carries a transducer which generates sound waves helping the computer create accurate images of surrounding tissue.
• CT Scan (Computed Tomography): In some cases, the doctor may recommend getting a CT scan done to get even clearer and accurate images of the gallbladder and surrounding organs. This is particularly recommended when the gallbladder stone ultrasound results are not very clear and the patient is having some complications due to gallbladder stones.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): This procedure is carried out to diagnose the problems in the bile and pancreatic ducts. In this procedure, an endoscope is passed through the mouth, esophagus, stomach and duodenum. Subsequently, a dye is injected inside the ducts, and X-ray images are captured to trace the gallstones that have breached into bile ducts.
• Magnetic resonance cholangiopancreatography (MRCP): This is a kind of MRI to trace the gallstones in the bile ducts even more precisely. This is a completely non-invasive technique that helps in producing very clear images of the biliary system, including the common bile duct.
• Cholescintigraphy (HIDA Scan): This medicine test checks the functioning of the gallbladder and biliary system. In this test, the doctor injects a radioactive tracer into the bloodstream, and uses a camera to track its uptake and excretion by the liver and gallbladder.
• Cholescintigraphy: In this procedure, the doctor injects a radioactive material into a vein in the arm, and then a special camera captures its images as it passes through the biliary tract. This procedure helps in diagnosing abnormal contractions in your gallbladder or an obstruction in the bile ducts.
• Blood tests: Sometimes, the doctor may have to run some blood tests on the gallbladder stone patient to diagnose any complications like infection, jaundice, pancreatitis, etc.

Depending upon the size and number of the gallbladder stones, the patient's symptoms and overall health and the risk of complications, doctors may choose between surgical and non-surgical treatment methods for the treatment. Let us explore both the options one by one:

Generally, non-surgical methods of gallstone treatment focus on managing the symptoms. There, however, are some methods aimed at breaking or dissolving the gallstones that are smaller in size. Non-surgical methods of gallstones treatment include:

• Observation and Monitoring: When the gallstones are not causing any symptoms, you may be advised to just observe and monitor your condition through regular follow-ups and imaging tests to track the changes in the gallstones.
• Medications: In some cases, the healthcare practitioner may prescribe some medicines to aid in dissolving gallbladder stones over time. Ursodeoxycholic acid (UDCA) is the most commonly prescribed medicine for dissolving gallstones as it reduces the cholesterol production by the liver, thus, helping in dissolution of cholesterol gallstone. Chemicals like ursodiol or chenodiol are also used to dissolve gallbladder stones. These medicines help in thinning the bile, which promotes gallstone dissolution.
• Extracorporeal Shock Wave Lithotripsy (ESWL): This is a non-surgical method for managing or treating gallstones. This procedure is recommended to those whose gallbladder is working properly and the size of their stones is small. In this method, high energy sound waves are used to produce strong enough shock waves that fracture and disintegrate gallbladder stones.
• MTBE Injection: This is yet another non-surgical treatment option for gallstones. In this procedure, a solvent called methyl tertiary-butyl ether (MTBE) is injected into the gallbladder that quickly gets to dissolving the gallstones. This procedure, however, comes with some side effects like severe burning pain. This procedure carries a lot of risks and hence, patients are advised to check the doctor's experience with this particular treatment option before undergoing it.
• Endoscopic Drainage: This non-surgical method is used to manage gallstone-related complications, especially when the stone obstructs the bile ducts. It works just like the healthy route of bile from the gallbladder to the small intestine. In this procedure, the cystic duct is accessed using a camera inserted through the mouth and down the throat. Subsequently, a wire is inserted through the duct into the gallbladder. This procedure is aimed at creating the same process that of a healthy gallbladder, in which the bile comes out through the small intestine.

While the above-mentioned approaches can help in managing symptoms of gallbladder stones, surgery is the ultimate solution for gallbladder stones. Gallstone surgery is also known as cholecystectomy. When gallstones start to show symptoms or complications, doctors recommend you to go for gallbladder stone removal surgery which helps in getting long-term relief. About 80 percent of the people with gallbladder stones eventually have to undergo surgery for relief.

Mainly, there are two types of cholecystectomy:

• Laparoscopic Cholecystectomy (keyhole surgery): It is the most common and successful method for gallbladder stone treatment. Doctors make a few small incisions in the abdominal area to insert a thin, flexible tube with a camera attached to the top, known as a laparoscope, and other surgical tools. Then carbon dioxide is used to inflate your abdomen so that the doctor can clearly view the abdominal area and work with surgical tools. The laparoscope helps in visualising the nearby structures on a screen. Using the surgical tools, the surgeon detaches the gallbladder from its attachments, bile ducts and blood vessels.
• After the detachment, the gallbladder is removed through one of the incisions made on the abdominal area. Post extraction, the incisions are closed using stitches. Laparoscopic cholecystectomy is minimally invasive, which ensures less pain, quick recovery, and minimal scarring.
• Open Cholecystectomy: In some cases, laparoscopic cholecystectomy is not possible due to complications, several scars from previous surgeries, or any particular medical condition. Hence, doctors have to go for open cholecystectomy. In this procedure, the surgeon makes a big incision in the abdomen, to get direct access to the gallbladder and remove it.

Both, laparoscopic and open cholecystectomy are very effective modes of treatment for gallbladder stones. Once the gallbladder is removed, the bile produced by the liver flows directly into the small intestine. The absence of the gallbladder does not directly impact the patient's health or digestion ability. After open cholecystectomy, the patient, however, takes longer to recover because of the bigger incision.

Laparoscopic surgery for gallstones or laparoscopic cholecystectomy is clearly more beneficial than its traditional alternative, open cholecystectomy. The decision to choose which one suits your requirements completely lies on the doctor. Here are some of the most significant benefits of laparoscopic cholecystectomy:

• Minimally Invasive: Being a minimally invasive surgical procedure is the most significant benefit of laparoscopic cholecystectomy. It leaves smaller scars and causes less trauma to the nearby tissues, as compared to the open cholecystectomy.
• Less Pain: The postoperative pain in laparoscopic cholecystectomy is way lesser than in open cholecystectomy because of smaller incisions and reduced tissue trauma.
• Faster Recovery: As surgeons use smaller incisions in laparoscopic cholecystectomy, it ensures the patient recovers quickly and returns to work within a few days to a week after the surgery.
• Lower Risk of Complications: Laparoscopic surgeries have proven to carry a smaller risk of complications like wound infection and incisional hernias.
• Cosmetic Benefits: Smaller incisions leave smaller scars, which in itself is a cosmetic benefit of laparoscopic cholecystectomy.
• Effective Gallbladder Stone Removal: Just like open cholecystectomy, laparoscopic cholecystectomy also removes the gallbladder effectively, ensuring long-term relief for the patient.
• Accurate Visualisation: Laparoscopes carry a high-definition camera attached at the top of them, which allows the surgeon to clearly see the internal body parts. This results in more precision and ability to perform the surgery effectively.
• Reduced Bowel Disturbance: Laparoscopic cholecystectomy does not affect the bile duct or the nearby areas, which lowers the risk of postoperative bowel disturbance, including diarrhoea or fat malabsorption.

Gallstone surgery is generally considered a safe procedure, still it too can pose a few risks and complications like any other surgical procedure. Hence, you are advised to discuss these risks and complications with your surgeon before you go for gallbladder removal surgery. Some of the risks and complications are listed below:

• Infection: Like all surgeries, laparoscopic or open cholecystectomy also carry a slight risk of causing an infection at the incision area or within the abdominal cavity. To reduce the risk of infection even further, doctors administer antibiotics before and after the surgery.
• Bleeding: A small amount of bleeding is expected to occur during the surgical procedure, but if the bleeding happens after the procedure, or in rare cases, bleeding is extreme during or after the surgery, it may require additional intervention.
• Bile Duct Injury: In rare cases, the bile duct may get damaged during the surgery, which leads to leakage or obstruction of bile. This complication requires additional procedures to fix the bile duct.
• Bile Leak: In some cases, the patient may go through a small bile leak from the ducts or the gallbladder bed. Most of the time, it does not require any additional intervention, but some cases may require further treatment.
• Adverse Reaction to Anesthesia: Despite being very rare, some people may experience adverse reactions to anaesthesia, like respiratory issues, allergic reactions or some other complications.
• Blood Clots: Post gallbladder removal surgery, there is a slight risk of developing blood clots in the legs or lungs, which are known as deep vein thrombosis and pulmonary embolism, respectively. To reduce the risk of developing these conditions, doctors recommend patients to walk around after surgery.
• Organ Damage: Every surgery poses a slight risk of damage to the tissues of nearby organs. Similarly, in this surgery, intestines, liver and pancreas may suffer some damage.
• Cardiovascular Complications: People with underlying heart conditions may be at a small risk of suffering from cardiovascular complications.
• Postoperative Pain: Every surgery poses some risk of mild to moderate postoperative pain, which is easily manageable through pain medications.
• Incisional Hernia: Every surgery that requires some incisions poses a risk of developing incisional hernia. It happens when the muscles of the abdominal area get weak and tissues protrude through the incision site.
• Delayed Healing: In some patients of gallbladder removal surgery, wound healing may be slower than usual. This may lead to infections or prolonged recovery.
• Digestive Changes: Once your gallbladder has been removed, you may experience some changes in bowel movements and digestive issues

The chances of occurrence of these complications is already very rare, which reduces further in case you go for a laparoscopic cholecystectomy.

Lybrate has a nexus of highly equipped hospitals and clinics, and greatly skilled doctors, who have years of experience in laparoscopic gallbladder removal surgery. Here is the list of benefits of choosing Lybrate for your surgery:

• Follow-up Consultations: We also provide you with follow-up consultations after the surgery, which sets us apart in terms of patient care from the rest.
• Technology: Our hospitals and clinics are equipped with state-of-the-art facilities and our doctors are well versed with them.
• No-Cost EMI: If you find the cost of a surgery too much, you can opt for the no-cost EMI option as well to pay for it and live a healthy life.
• Pick and Drop Facility: Lybrate also provides pick and drop facility to the patients on the day of the surgery.