Removal of gallbladder often best treatment for gallstones

Q: I was recently diagnosed with gallstones, and my doctor recommended surgery. Is this the best option, or can I consider other treatments?

A: Gallstones are pebble-like deposits that form inside the gallbladder, a pouch that sits below the liver. It collects bile that has been made in the liver, then releases it into the small intestine through narrow tubes called bile ducts. Bile is a fluid that helps with digestion. It contains salts, cholesterol and bilirubin.

Normally, this mix is a liquid. However, under certain conditions, some of the bile forms a solid lump, or a stone, that gets progressively larger.

Most of the time, gallstones do not cause any problems; you don't even know you have them. They cause symptoms if they block the normal flow of bile. This can happen when they at least partially block the tube that carries bile from the liver to the gallbladder, or cause a blockage in the tube that carries bile from the liver and gallbladder into the intestine. (I've put an illustration of gallstones on my website, AskDoctorK.com.)

Gallstones can cause many different symptoms. The most common are abdominal pain, belching, gas, nausea and a decreased appetite.

More serious problems can develop if a gallstone gets caught in a small tube called the common bile duct, which leads to the small intestine. The stuck stone can lead to inflammation and bacterial infection of the gallbladder (cholecystitis).

If a small gallstone blocks the tube carrying enzymes from the pancreas into the small intestine, it can cause a very serious infection or inflammation of the pancreas (pancreatitis). The tube from the pancreas enters the small intestine right where the tube from the liver and gallbladder does. That's how a gallstone made in the gallbladder can eventually block the tube from the pancreas.

Nonsurgical treatments are available, but surgical removal of the gallbladder is often a better choice. Indeed, sometimes it's absolutely necessary because gallstones will continue to re-form until the gallbladder is surgically removed.

The most common gallstone surgery is laparoscopic cholecystectomy. In this procedure, a surgeon makes small incisions in the abdomen. He or she uses miniature surgical instruments to remove fluid and stones from the gallbladder, then pulls out the gallbladder through one of the small holes. Some patients require a larger incision.

For stones that are caught in the common bile duct, an additional treatment (called ERCP, for short) might be required. During ERCP, a surgeon uses miniature surgical tools to tug a stone out of the bile duct, or to widen the lower part of the duct so that the stone can pass out into the intestine on its own.

For people who cannot tolerate surgery, an oral medication can help dissolve stones. This treatment usually takes at least six months to work, and it is effective in only about half of patients. Once the medication is stopped, gallstones are likely to return. Shockwaves and solvents injected directly into the gallbladder can also be used to break up gallstones.

• Dr. Anthony Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.