Liver forms bile continuously. This gets stored in the gallbladder. Following a fatty meal, a signal from the stomach induces the gallbladder to contract and push bile out into the common bile duct. The common bile duct opens along with the pancreatic duct in the duodenum. Thus, fatty material in the food is broken down into tiny fragments that can be easily digested by the small intestine.

A Gallstone is a stone which develops inside the gallbladder. There are two types of gallstones – cholesterol and pigmented. In India, gallstones are 80% cholesterol and 20% pigmented variety. Some proportion of cholesterol stones have lesser proportion of cholesterol and more of calcium. Most gallstones found in the western countries are primarily cholesterol. 

Consumption of foods rich in cholesterol is considered a risk factor. This risk increases with age. This is a major risk factor for the cholesterol stones. Pigmented stones are formed in people who suffer from a disease where there is self-destruction of red blood cells such as sickle cell anemia. Pigmented stones are commonly found in Asian and African populations. There are other risk factors for gallstones like oral contraceptive pills, rapid weight loss, obesity, frequent fasting, family history, lack of physical activity, diabetes mellitus, cirrhosis, and certain medications like octreotide, estrogens, fibrates.

Female hormone - Estrogen increases cholesterol secretion whereas Progesterone promotes biliary stasis. These two hormones contribute in combination to form a gallstone. Also, pregnant women are more likely to form gallstones due to the hormonal influences and decreased intestinal function. A general dictum says women who are fat, had multiple pregnancies, around forty years of age, are more likely to develop gallbladder stones.

In many cases, more than one of these factors plays a roll, but some people form stones without any known risk factors. 

Cholecystitis is a condition where an inflammation occurs in the gallbladder.  This inflammation usually occurs following blockage to bile flow from the gallbladder into the common bile duct commonly due to stone or infection of biliary tract.

The most common symptoms are:

Severe upper abdominal pain – below the rib cage either in the middle, or on the right side. The pain may spread to the back or the right shoulder

- Pain may follow a large fatty meal

-  Nausea, Vomiting

- Fever

-  Malaise

These problems include polyps, inflammation without gallstone and gallbladder cancer.

Polyp is a swelling of the innermost lining of the gallbladder. Polyps are associated with a potential for cancer, but this is relatively rare. Generally, no surgery is offered for polyps upto 1cm. Polyps larger than 1 cm have a potential to turn into cancer. Here, surgery is indicated. 

In this condition, gallbladder becomes inflamed and fails to empty bile, in the absence of stone. This condition is usually seen in long duration ICU admitted patients, receiving total parentral nutrition, severe burns, malignancy. The symptoms and treatment remain the same.  

Asymptomatic gallstone may be left untreated except in high risk groups like diabetes. The treatment of symptomatic gallstone or cholecystitis is surgical removal of the gallbladder.

Treatment of acute cholecystitis depends on the severity of the attack. In severe cases, therapy initially is supportive with antibiotics, painkillers, intravenous fluid replacement, and nasogastric suction (a tube placed through the nose into the stomach) for the first two to three days. Surgery is then performed to remove the gallbladder. 

There are two options - conventional surgery and laparoscopic surgery.

Conventional surgery involves a cut to visualize the gallbladder adequately. This can be even bigger in the presence of acute attack. A laparoscopic surgeon makes four to five cut ranging from 5 – 10 mm. The advantages of this technique make it, the gold standard treatment for cholecystitis or gallbladder stone. Laparoscopic method has now virtually replaced the open procedure for the treatment of gallbladder disease.

The laparoscopic surgeon performs the same surgery as in the conventional approach. He identifies the cystic duct and artery separately. These two structures are divided between clips. Next, the gallbladder is separated from the liver bed. The gallbladder is removed out through one of the incisions. Lastly, the laparoscopic surgeon checks for any bleeding or injury during surgery. The muscle openings of 10 mm size cut are closed and skin is closed with absorbable sutures. The patient is discharged on the next day after a wound check. 

No. The option of removing stone remains only for kidney stones. In case of gallstones, this is not an option. As the gallbladder is diseased, it would continue to form gallstones.

Hence, the best treatment is its removal. 

Even a swollen diseased gallbladder can be removed easily only by stretching the muscle below. Occasionally, the muscle opening needs to be extended in case of large stones or acute infection. 

1.   Less post-operative pain

2.   Faster recovery

3.   Short hospital stays

4.   Lesser post-operative complications like wound infection, adhesion, hernia, etc.

5.   Cost-effective in working group

After completion of laparoscopic surgery, the patient can start drinking liquids after about 6 hours. This is the approximate time for the patient to recover from the anasthesia and tolerate oral intake. The patient can be active at the hospital depending upon the pain, like walking to the rest room. The next morning, patient is allowed light breakfast and discharged later in the afternoon, after ensuring bowel movement (patient should pass gas). They can climb stairs and get back home. Work is resumed by most patients in 5 – 7 days. 

The operation is ideally suited for obese patients. In a conventional surgery, the obese patient requires a longer cut. This results in more pain, wound related problems like bleeding, infection. Such patients should be seen the anesthetist prior to surgery for pre-operative and intra-operative planning. Newer anesthetic agents have also helped in such patients.