Approximately 1 in 12 adults in the United Kingdom have gallstones. About 50,000 of these patients have gallbladder surgery each year.
A gallstone is a crystalline concretion formed within the gallbladder by accretion of bile components. Gallstones can vary in size and shape from as small as a grain of sand to as large as a golf ball. The gallbladder may contain a single large stone or many smaller ones. These calculi are formed in the gallbladder, but may pass distally into other parts of the biliary tract such as the cystic duct, common bile duct, pancreatic duct, or the ampulla of Vater. Once gallstone symptoms appear, they recur in the majority of patients therefore most symptomatic patients should be treated. In addition to biliary colic (pain), presence of gallstones in the gallbladder may lead to acute cholecystitis, an inflammatory condition characterized by retention of bile in the gallbladder and often secondary infection by intestinal microorganisms. Presence of gallstones in other parts of the biliary tract can cause obstruction of the bile ducts, which can lead to serious conditions such as ascending cholangitis or pancreatitis. Either of these two conditions can be life-threatening, and are therefore considered to be medical emergencies.
Cholecystectomy (gallbladder removal) has a 99% chance of eliminating the recurrence of cholelithiasis. Laparoscopic (keyhole) cholecystectomy has now replaced open cholecystectomy as the first-choice of treatment for gallstones and inflammation of the gallbladder, unless there are contraindications to the laparoscopic approach. Laparoscopic cholecystectomy requires several small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5 to 10 mm in diameter, through which surgical instruments and a video camera are placed into the abdominal cavity. Because of the pain associated with the large incision that was required the old-fashioned open cholecystectomy, patients invariably stayed in hospital for 5-7 days, however these days, laparoscopic cholecystectomy typically includes a same-day discharge from hospital followed by a few days of home rest.