Q1. What are the symptoms of gallstones?
Most patients may show no symptom despite gallstones in their gallbladders. However, if they block the cystic duct, which is the outlet of gallbladder, and stop the bile from flowing into duodenum, the obstruction may cause pain in the upper right abdomen. It usually happens when one is eating or prepares to eat.

The pain may extend from the upper right abdomen to near scapula in the right back. It is common in patients with gallstones. Acute cholecystitis occurs if the cystic dust is blocked completely by gallstones. Even if one stops eating, the pain may continue with other acute symptoms such as fever and increasing pulse rate.  If you feel pain at the centre of the upper abdomen or on an empty stomach at night, it may have to do with duodenum or gastric ulcer. Gastroscopy is recommended.

Q2. How are gallstones formed?
To know more about gallstone formation, let’s talk about what constitutes bile first. Bile is composed of water, bile salt and cholesterol. A gallstone is formed if the bile salt and steroid increase in concentration, almost to the point of saturation. In people who get used to not drinking water or eating for a long period, the now highly concentrated bile will coagulate and form gallstones.   

Q3. Is treatment necessary for gallstones?
As said earlier, gallstone patients may have no symptoms or feel no pain at all. However, frequent pain or chronic cholecystitis may occur if the cystic duct is blocked. Acute cholecystitis may occur in case of serious blockage. In both situations, the gallbladder has to be removed along with the gallstones.    

Q4. Which should be removed? Gallstones or gallbladder?
Many people wonder if gallstones or gallbladder should be removed. The truth is both are taken out in cholecystectomy. How about keeping the gallbladder but not the gallstones? In recent years, some doctors did suture the gallbladder after removing the gallstones. But in most cases surgery is required again soon, as those gallstones are formed in gallbladder wall. They may recur soon after surgery even if the gallbladder is kept intact. Cholecystectomy is thus performed to remove the gallbladder with the gallstones.   

Q5. How is the gallbladder removed?
A minimally invasive approach has long been adopted in cholecystectomy since the late 80s. To remove a gallbladder, three to four incisions are made on the belly. Minimally invasive cholecystectomy is carried out in about 97% of cases, while it may be too difficult to perform in the remaining 3% due to tissue adhesion caused by frequent cholecystitis, or structural abnormality of the gallbladder and nearby blood vessels. For safety reasons, conventional open surgery is preferred.  In general, patients need to stay in the hospital for just 2 to 3 days and enjoy faster recovery after minimally invasive surgery.

Q6. How can the removal of gallbladder impact the daily life?
Most people think that there will be no more bile after removal of gallbladder. It is a misunderstanding. Bile is made by the liver. Though there is no longer a gallbladder to store the bile after surgery, the liver will continue to produce bile. While some patients may have to go to toilet an hour or so after eating high-fat food, the same problem is not found in patients with their gallbladders removed after surgery. Due to chronic cholecystitis, the gallbladders of those patients have already failed to function before removal.  The day-to-day impact of gallbladder removal is thus minimal. There is no need for undue concern as long as you eat less high-fat food.

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