Gallstones

Our Approach to Managing Gallstones

Diagnose accurately. Treat the cause. Prevent complications.

Gallstones are remarkably common - present in up to 10% of the adult population - yet only a fraction of those affected ever develop symptoms requiring treatment. The clinical challenge is distinguishing patients with simple, silent gallstones who need only observation from those experiencing genuine biliary colic symptoms, acute cholecystitis, or migrated stones causing pancreatitis or jaundice - situations that demand timely surgical or endoscopic intervention.

At Shree Hospitals, our approach to gallstone diagnosis and biliary pain management is grounded in careful clinical correlation with imaging findings. Our gallbladder removal specialists ensure that every patient receives the right treatment at the right time - whether that means reassurance and dietary advice for an incidental finding, or urgent surgery for acute cholecystitis.

1. Accurate Diagnosis & Risk Assessment
   

• Abdominal ultrasound - the primary diagnostic tool, identifying gallstones, gallbladder wall thickening, and pericholecystic fluid with high sensitivity
• Liver function tests - assessing for biliary obstruction; elevated bilirubin or alkaline phosphatase suggesting bile duct stone migration
• MRCP (Magnetic Resonance Cholangiopancreatography) - non-invasive bile duct imaging for suspected bile duct stone removal candidates
• CT abdomen for complicated presentations - assessing for gallbladder perforation, abscess, or associated pancreatitis
• HIDA scan in selected cases of acalculous biliary pain where ultrasound is inconclusive
• Clinical correlation distinguishing simple biliary colic from acute cholecystitis, cholangitis, or gallstone pancreatitis - each requiring distinct urgency and management

2. Conservative Management for Asymptomatic Gallstones
   
   Not every gallstone requires surgery:

• Incidentally discovered, asymptomatic gallstones in low-risk patients may be safely observed without intervention
• Dietary modification - reducing fatty food intake to minimise gallbladder stimulation and symptom frequency
• Clear patient education on warning signs requiring urgent review - persistent pain, fever, or jaundice
• Selective prophylactic cholecystectomy considered in specific high-risk groups - diabetic patients, those with porcelain gallbladder, or large stones above 3 cm with elevated cancer risk

3. Laparoscopic Cholecystectomy

    

   The definitive and most commonly performed treatment for symptomatic gallstones:

• Four-port standard laparoscopic technique - gallbladder removed through small keyhole incisions with excellent cosmetic and functional outcomes
• Single-incision laparoscopic cholecystectomy (SILS) - a single small umbilical incision for suitable candidates seeking minimal scarring
• Intraoperative cholangiogram when bile duct stones are suspected - confirming clearance of the biliary tree during the same procedure
• Critical View of Safety technique - a rigorous dissection protocol minimising the risk of bile duct injury during laparoscopic cholecystectomy and gallbladder surgery in Mumbai
• Same-day or next-day discharge for the majority of elective cholecystectomy patients

4. Management of Acute Cholecystitis
   
   Gallbladder inflammation requires prompt, structured treatment:

• IV antibiotics and fluid resuscitation on admission - controlling infection and inflammation before surgery
• Early laparoscopic cholecystectomy within 72 hours of symptom onset - proven to reduce complication rates compared to delayed surgery
• Percutaneous cholecystostomy drainage for critically unwell or high-surgical-risk patients unable to tolerate immediate surgery
• Interval cholecystectomy planned after recovery for patients initially managed with drainage alone

5. Bile Duct Stone Management

    

   When gallstones migrate into the common bile duct, causing obstructive jaundice or cholangitis:

• ERCP (Endoscopic Retrograde Cholangiopancreatography) - endoscopic bile duct stone removal using sphincterotomy and balloon or basket extraction
• Same-admission ERCP followed by laparoscopic cholecystectomy - the preferred sequence for most patients with concurrent gallbladder and bile duct stones
• Laparoscopic common bile duct exploration - performed during cholecystectomy in selected cases as an alternative to ERCP
• Emergency ERCP for acute cholangitis - biliary sepsis requiring urgent decompression alongside IV antibiotics

6. Post-Operative Care & Long-Term Outcomes

• Early mobilisation and return to normal diet within 24 hours of laparoscopic cholecystectomy
• Most patients resume normal activity within 1 week and full activity including exercise within 2 to 3 weeks
• Dietary guidance for post-cholecystectomy adjustment - most patients tolerate a normal diet well without long-term restriction
• Management of rare post-cholecystectomy syndrome - persistent symptoms requiring further investigation for retained stones or other causes
• Structured follow-up ensuring complete recovery as part of comprehensive Gallstones treatment in Mumbai, India