Biliary Colic, Acute Cholecystitis, and Laparoscopic Cholecystectomy
 
Gallstones are hard deposits that form in the gallbladder, a small pouch beneath the liver that stores bile used to digest fat. Gallstones are very common and often cause no symptoms at all

Biliary colic occurs when a gallstone temporarily blocks the opening of the gallbladder causing it to contract against the blockage

• Sudden intense pain in the upper right or central abdomen sometimes spreading to the right shoulder blade or back
• Pain that often follows a fatty or large meal
• Episodes typically last 30 minutes to a few hours then ease on their own
• Nausea sometimes vomiting
• Fevers are uncommon: can help differentiate from cholecystitis

The pain comes from the gallbladder squeezing against a temporarily blocked outlet. Once the stone shifts position and the blockage releases the pain resolves. Between episodes, the gallbladder is not inflamed and blood tests are usually normal

Acute cholecystitis develops when a gallstone blocks the gallbladder outlet persistently leading to inflammation and sometimes infection of the gallbladder wall

• Constant pain in the upper right abdomen lasting more than a few hours
• Tenderness when the area is pressed, often worse on breathing in
• Fever and chills
• Nausea and vomiting
• Loss of appetite

Unlike biliary colic, acute cholecystitis does not settle on its own within a few hours. The gallbladder wall becomes inflamed and can become infected. This condition usually requires hospital assessment, antibiotics and often surgery

• Severe abdominal pain lasting more than a few hours
• Fever or shaking chills
• Persistent vomiting or inability to keep fluids down
• Yellowing of the skin or eyes (jaundice)
• Pale stools or dark urine

A laparoscopic cholecystectomy is minimally invasive (keyhole) surgery to remove the gallbladder. It is the standard treatment for biliary colic and for acute cholecystitis and is one of the most commonly performed operations worldwide

• Performed under general anaesthetic
• 4 small incisions (around 0.5–1 cm each) are made in the abdomen
• A camera (laparoscope) and fine instruments are inserted through the incisions
• The gallbladder is carefully separated from the liver & surrounding structures and removed through one of the incisions
• Typically takes 45–90 minutes

The gallbladder is not essential for life. Once stones have formed, they tend to recur and because the gallbladder itself is the source of the problem, removing it addresses the underlying cause and prevents further episodes of colic or cholecystitis. Bile continues to flow from the liver directly into the intestine after the gallbladder has been removed

• Most people go home either the same day or after one night in hospital
• Shoulder-tip discomfort is common for 24-48hrs after the operation which is from gas used during surgery
• Most people return to normal activities within 1-2 weeks
• Heavy lifting is usually avoided for 4–6 weeks
• Driving avoided for 1-2 weeks