Gall stone

A Gall stone (also sometimes spelled Gallstone) is a usually round hardened fatty substance that is produced in the gall bladder as a result of a malfunction of the gall bladder. A healthy, functioning, gall bladder will never produce a gall stone.

The normal function of the gall bladder is to help to digest food, remove unwanted bacteria and generally assist the digestive system. For a variety of reasons, on some occasions a gall bladder may cover a piece of fatty substance with bile, hardening and compacting it such that it becomes lodged within the gall bladder rather than being digested. This is how a gall stone is created.

Once a gall stone is created, it typically does not make any difference to the patient's life. Most people with gall stones are unaware that they even have them. There is no need to remove a gall stone just because there is 1 solitary gall stone in the gall bladder that is not causing any symptoms.

At some point in time, the gall stone may become dislodged from the gall bladder and move correctly towards the digestive system, where it is digested. Whilst this may create a painful defaecation, it otherwise has no major problems.

Unfortunately, typically by the time that the gall stone becomes dislodged, it is no longer able to be digested and as such it can become lodged in an orifice within the body, which creates extreme amounts of pain and can potentially be fatal.

Under such circumstances that a gall stone becomes blocked in an orifice, an emergency cholelithotomy (gall stone removal) may be performed. Some surgeons may opt to at that point also perform a cholecystectomy (gall bladder removal), although this is not recommended in patients with underlying digestive system problems, such as acid reflux, anaemia or allergy symptoms, as removing the gall bladder in patients who desperately need it can create long-term morbidities and lead to premature death some time in the future, as well as a greatly reduced quality of life, due to change in diet and lifestyle to cope with life without a gall bladder.

Gall stone removal versus Gall bladder removal is always a difficult decision and the pros and cons of the decision needs to be discussed with a patient before proceeding. In a patient who has no digestive system problems who has a grossly malfunctioning gall bladder, producing multiple gall stones and whose general structure is deteriorating, the decision to proceed to a cholecystectomy is not a difficult one. Similarly, in a patient who has a solitary gall stone, even if it does obstruct an orifice, cholecystectomy is never indicated, and is particularly ill-advised if the patient additionally suffers from digestive system problems. Unnecessary gall bladder removal is a common mistake of inexperienced surgeons.

In most patients, removal of the gall bladder or not makes no difference, with no requirement to modify their diet, or change anything about them at all. Similar to removing a kidney, in most healthy people (or otherwise healthy, other than gall bladder issues), there is no problem whatsoever in removing the gall bladder, which leads to a common mistake amongst inexperienced surgeons to remove the gall bladder "just in case", or who may remove the gall bladder when they see a single stone become blocked in an orifice. This can, however, cause long-term problems in patients who have ongoing digestive system problems, and the surgeon must always weigh up the pros and cons of surgery, which must be discussed with the patient.

If a patient is in an emergency life-threatening situation related to a gall stone (as opposed to an inflamed or disintegrating gall bladder), it is never a problem to perform a cholelithotomy only, just in case they are a patient who urgently requires the use of their gall bladder. A cholecystectomy can always additionally be performed at a later date.