Gallstones and Gallbladder Disease - Highlights

Highlights

Overview:

• Gallstones are small, hard deposits that can form in the gallbladder, a sac-like organ that lies under the liver in the upper right side of the abdomen.
• The process of gallstone formation (cholelithiasis) is generally slow, and usually most gallstones do not cause pain or other symptoms.
• Women (particularly if pregnant), diabetics and overweight individuals are at increased risk for developing gallbladder disease.
• Gallbladder cancer is rare. Survival rates are one the rise, but there are still some deaths because the disease is often diagnosed at a late stage. Removing the gallbladder is the only way to cure gallbladder cancer.

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Treatment:

• Removal of the gallbladder can be safely performed during open, small incision or laparoscopic surgery (robot or human assisted). Laparoscopic surgery is the most common technique today. A review of these surgical approaches showed no difference in mortality or complication rates. Faster recovery times are reported after the less invasive options (small incision and laparoscopic). Small incision appears to offer the shortest overall surgical time and least costly method.
• A systematic review comparing robot-assisted and human assisted removal of the gallbladder showed no difference in morbidity, conversion to open surgery, total operating time, or hospital stay. Robot-assisted surgery requires longer overall surgical time and is more costly.
• A new procedure called Natural Orifice Translumenal Endoscopic Surgery (NOTES) is enabling surgeons to remove the gallbladder through the mouth, stomach, rectum or vagina. Preliminary evidence suggests that transvaginal and transgastric (through the stomach) have been performed safely. A handful of hospitals across the US are beginning to perform this type of surgery, which is still considered experimental.
• Treatment approaches for patients with little pain and no other complications may include watchful waiting, pain medication, drug dissolution therapy and lithotripsy (stone-breaking technique). Some patients may elect surgical removal.

Review Date: 06/10/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org).