Treating Gallstones and Bile Duct Stones

Gallstones and bile duct stones may be treated first with antibiotics to help control infection. They also can be treated at the time of diagnosis with miniaturized surgical instruments inserted through an ERCP. Alternatively, stones may be treated with medications that dissolve them, with lithotripsy that uses sound waves to break them up, or with surgery to remove the gallbladder.

ENDOSCOPIC TECHNIQUES
When a stone has been identified on x-ray, ultrasound or MRI imaging as blocking a bile or pancreatic duct, it can be removed with miniaturized instruments inserted through the ERCP. These surgical instruments gently enlarge the ductal opening that then allows the stone to be removed.

MEDICATIONS
Medications can be given that dissolve gallstones but they are not always effective and are not indicated in all cases. The most common medication is a bile salt (ursodiol) that slowly dissolves cholesterol within the stones. However, the stones can return when the medication is discontinued.

EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY
This treatment employs high-frequency sound waves to break up gallstones. Patients then take bile salt tablets, sometimes indefinitely, to dissolve the pieces and to ensure that the stones do not return. Only a minority of patients are candidates for this type of treatment, however. The best candidates have a single small stone. If an infection (cholangitis) or inflammation (cholecystitis) of the gallbladder is present, lithotripsy is not an option. Extracorporeal (meaning outside of the body) shock wave lithotripsy is performed by directing pulsating, high-intensity sound waves at the area where the stone is located, identified first by ultrasound. The procedure takes about 45 minutes and patients are usually lightly sedated before treatment.

SURGERY
Surgery to remove the gallbladder, called cholecystectomy, is a common procedure in the United States for individuals with symptoms caused by gallstones. Virginia Mason was one of the first medical centers in the country to remove the gallbladder by the minimally invasive laparoscopic approach, called laparoscopic cholecystectomy.

This minimally invasive surgery for removing the gallbladder is one of the most common procedures performed at Virginia Mason and is, in fact, the preferred approach today for removal of the gallbladder. In cases in which a gallstone or bile stone has blocked a bile duct - a situation that can lead to infection or inflammation of organs within the biliary tract - surgeons will likely recommend removal of the gallbladder.
Laparoscopy
During laparoscopy, the surgeon makes several ¼ to ½ inch incisions in the abdomen. He or she then inserts miniaturized endoscopic and surgical instruments, and a small camera, through these "ports." Images from the camera are sent to a video monitor that allows the surgeon to "deflate" and then remove the gallbladder through one of the ports. Individuals return to their regular activities often within a few days.

Open surgery
Sometimes the surgeon must revert to an open surgical procedure during a scheduled laparoscopy to remove the gallbladder. These occurrences happen infrequently and are most often caused when the gallbladder is found to be infected or when the gallbladder lining is hardened, making it more difficult for the organ to be removed laparoscopically.

At other times, the surgeon may make the decision that the open surgical procedure is the best option for the patient based on the severity of the individual's gallbladder disease. Open surgery involves making a large incision in the abdomen and removing the gallbladder. Recovery time is longer, five to seven days in the hospital, and there is a longer return to daily activities: two to three weeks, for example.