Gallstones: Causes, Symptoms, and Surgical Treatment Options Explained by a Doctor

Gallstones: Causes, Symptoms, and Surgical Treatment Options Explained by a Doctor. Image by Health Facts by Dr Pasindu using Google Gemini AI

Gallstones are one of the most common digestive system problems worldwide, affecting millions of people every year. 

Recently, according to a study in the United States population, gallstone disease contributed to approximately 2.2 million ambulatory care visits, 1.2 million emergency department visits annually.

In the United Kingdom, the NHS reports that about 1 in 10 adults will develop gallstones at some point in their life. 

While many people live with gallstones without ever knowing it, others experience painful attacks and dangerous complications that require urgent medical attention.

As a doctor, my aim here is to give you a complete, guide that answers everything you need to know about gallstones — their causes, risk factors, symptoms, diagnosis, treatment options, surgery, recovery, and lifestyle advice. 

This article is based on evidence and guidelines, particularly the UK NICE guideline on Gallstone Disease, alongside references from trusted institutions like the NIH, NHS, and Mayo Clinic.

This is your one-stop resource — so you don’t need to read another article after this.

🟢 What Are Gallstones?

The gallbladder is a small, pear-shaped organ located under the liver on the right side of your abdomen. 

Its job is to store and release bile — a yellow-green fluid made by the liver that helps digest fats.

Gallstones are hardened deposits that form inside the gallbladder when bile contains too much cholesterol, too much bilirubin, or not enough bile salts. 

These imbalances cause crystals to form, which then stick together and grow into stones.

Gallstones can vary in size and number:

* Some are as small as grains of sand.

* Others can grow as large as a golf ball.

* A person may have just one large stone, or hundreds of smaller ones.

🟢 Types of Gallstones

There are three main types of gallstones:

1. Cholesterol Stones

   * The most common type (about 75–80% of cases in the West, according to Mayo Clinic).

   * Usually yellow-green.

   * Form when bile contains too much cholesterol.

2. Pigment Stones

   * Made of bilirubin, a substance produced when red blood cells break down.

   * More common in people with liver disease, cirrhosis, or certain blood disorders (e.g., sickle cell anaemia).

   * Typically dark brown or black.

3. Mixed Stones

   * Contain both cholesterol and pigments.

   * More common in the UK and US than pure pigment stones.

🟢 Why Do Gallstones Form? (Pathophysiology)

Bile normally contains cholesterol, bile salts, and waste products in a delicate balance. When this balance is disturbed:

* Too much cholesterol → crystals form.

* Too much bilirubin (from blood or liver disease) → pigment stones develop.

* Gallbladder doesn’t empty properly → bile becomes concentrated, promoting stone formation.

Think of it like leaving sugar in a cup of tea — if the liquid can’t dissolve it, crystals form.

🟢 Risk Factors for Gallstones

Doctors often summarize the main risks with the “4 F’s”: Female, Forty, Fertile, and Fat. 

But there are more.

1. Gender: Women are twice as likely to get gallstones due to oestrogen, which increases cholesterol in bile.

2. Age: Risk rises after 40 years old.

3. Pregnancy: Hormonal changes slow gallbladder emptying.

4. Obesity: Raises cholesterol levels in bile.

5. Rapid weight loss: After bariatric surgery or crash diets.

6. Diet: High in fat and sugar, low in fibre.

7. Family history: Inherited risk.

8. Medical conditions: Diabetes, cirrhosis, Crohn’s disease, sickle cell anaemia.

9. Medications: Oral contraceptives, hormone replacement therapy, and cholesterol-lowering drugs.

🟢 Symptoms of Gallstones

Many people have silent gallstones — no symptoms, discovered by chance on a scan. 

But when gallstones cause symptoms, they are often very painful.

Common Symptoms (Biliary Colic)

* Sudden severe pain in the upper right abdomen.

* Pain that radiates to the back or right shoulder.

* Pain triggered by fatty meals.

* Nausea and vomiting.

* Attacks lasting from 30 minutes to several hours.

Atypical Symptoms

* Indigestion.

* Bloating.

* Heartburn.

* Belching.

🟢 Complications of Gallstones

While many gallstones cause only occasional discomfort, some can lead to serious complications requiring hospital care.

1. Acute Cholecystitis (Inflamed Gallbladder)

   * Pain, fever, tenderness.

   * Requires antibiotics and usually surgery.

2. Choledocholithiasis (Bile Duct Stones)

   * Stones escape into the bile duct.

   * Causes jaundice (yellow skin), dark urine, pale stools.

3. Cholangitis (Bile Duct Infection)

   * Life-threatening infection.

   * Symptoms: fever, jaundice, abdominal pain.

4. Gallstone Pancreatitis

   * Stones block the pancreatic duct.

   * Severe abdominal pain, nausea, vomiting.

   * Can be life-threatening.

5. Gallstone Ileus (Rare)

   * Large gallstone blocks the intestine.

   * More common in elderly patients.

🟢 How Are Gallstones Diagnosed?

1. Ultrasound Scan

* First-line test (per NICE guidelines).

* Highly accurate.

* Non-invasive, painless.

2. Blood Tests

* Check for infection and liver function.

* High bilirubin = bile duct obstruction.

3. Advanced Imaging

* MRCP (Magnetic Resonance Cholangiopancreatography): Non-invasive MRI to see bile ducts.

* ERCP (Endoscopic Retrograde Cholangiopancreatography): Both diagnosis and treatment.

* CT scans: For complications.

🟢 Treatment Options

Silent Gallstones

* Do not require treatment.

* Only managed if symptoms or complications develop.

Symptomatic Gallstones

Non-Surgical Options

* Medications (ursodeoxycholic acid): Can dissolve cholesterol stones, but slow and stones often recur.

* Shock-wave lithotripsy: Rarely used, only in select cases.

Surgical Options (Gold Standard)

* Cholecystectomy (Gallbladder Removal):

  - Laparoscopic (keyhole) preferred.

  - Open surgery only if complicated.

* Day-case surgery: In the UK, many patients go home the same day.

🟢 Gallbladder Surgery: What to Expect

Before Surgery

* Blood tests, ECG, chest X-ray if needed.

* Stop certain medications temporarily.

During Surgery

* General anesthesia.

* 3–4 small cuts.

* Gallbladder removed.

After Surgery

* Go home same day or next.

* Return to work in 1–2 weeks.

* Light activity encouraged early.

Risks (Rare)

* Bile duct injury (0.3–0.5%).

* Infection.

* Retained stones in bile duct.

🟢 Life After Gallbladder Removal

* Most people live normally without a gallbladder.

* Bile flows directly from the liver to the intestine.

* Some may notice loose stools after fatty meals, but this usually improves.

* No major long-term dietary restrictions.

🟢 Diet and Lifestyle

Before Surgery

* Avoid fatty, greasy meals to reduce pain attacks.

After Surgery

* Start with light meals.

* Gradually return to normal diet.

* High-fibre foods improve digestion.

Preventive Diet (to lower gallstone risk)

* Mediterranean diet.

* Plenty of vegetables, fruits, whole grains.

* Healthy fats (olive oil, fish).

* Avoid refined carbs and high-sugar foods.

🟢 Myths About Gallstones

❌ “Gallstones always need surgery” → Not true, silent stones don’t.

❌ “Home remedies like apple cider vinegar dissolve gallstones” → No scientific evidence.

❌ “You can’t live without a gallbladder” → Most people live completely normal lives.

🟢 Public Health Perspective

* In the US, gallstones affect about 20 million adults (National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)).

* In the UK, around 60,000 gallbladder surgeries are performed every year (NHS).

* Gallstones are a major cause of hospital admissions and healthcare costs.

🟢 FAQs

Q: Can gallstones come back after surgery?

A: No, because the gallbladder is removed. Rarely, stones can form in bile ducts.

Q: Do gallstones increase cancer risk?

A: Very rarely. Long-standing untreated gallstones may slightly increase gallbladder cancer risk.

Q: Can children get gallstones?

A: Yes, but rare. More common in children with obesity or blood disorders.

Q: Do gallstones affect pregnancy?

A: Pregnancy increases risk due to hormones, but surgery is usually postponed until after delivery unless urgent.

🟢 Practical Checklist for Patients

* See a doctor if you have severe abdominal pain, jaundice, or fever.

* If diagnosed with gallstones, ask:

  - Do I need surgery now or can it wait?

  - What type of surgery do you recommend?

  - What is the recovery timeline?

  - What lifestyle changes should I make?

🟢 Conclusion

Gallstones are extremely common, and while many remain harmless, others can lead to painful attacks or serious complications. 

The good news is that treatment — particularly laparoscopic gallbladder removal — is safe, effective, and offers long-term relief.

By understanding the risk factors, symptoms, and treatment options, you can take control of your health and seek medical help at the right time.

📖 References

* NICE Guideline on Gallstone Disease (CG188)

* NHS – Gallstones Overview

* Mayo Clinic – Gallstones 

From Dr Pasindu 🥰

Stay happy stay healthy!

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Best Treatment for Wound Dehiscence and How to Prevent it?

Best treatment for wound dehiscence and how to prevent it? Photo by Alexander Grey:

Best treatment of wound dehiscence is a topic of great interest as wound dehiscence is one of the main complications that people face after a surgery. 

Depending on the site of the surgery and the severity, treatment of wound dehiscence differs but the distress people undergo remains almost the same.

 

What is Wound Dehiscence?

 

Wound dehiscence occurs as a complication when you receive sutures from a surgery. The wound edges may reopen partially or fully due to the defects in the wound healing mechanism making a new wound. 

Ultimate result is that wound will take a lot of time to heal causing you unnecessary trouble.

Usually, you will notice this within one week after surgery as during this time, the wound healing process is still in early stages.

There are two main aspects of wound dehiscence. 

Superficial wound dehiscence is when the most superficial layers of wound edges are separated whereas Full thickness dehiscence is when the underlying deep layers are also involved and separated completely.

In full thickness dehiscence, if the wound is situated on a cavity as in the abdomen, this can open a pathway from the inside of the cavity to the outside as well. If so, there is a risk of internal organs coming out of this pathway. This is Evisceration. 

Evisceration is a very dangerous consequence of wound dehiscence that needs urgent proper treatment.

Tensile Strength

During the first few days of the skin wound, the tensile strength of the wound is minimal. But as the collagen tissue forms, the wound tissue will increase its tensile strength over time. 

Thus, wound dehiscence is more likely during the first few days of the wound.

  

Causes and Risk Factors of Wound Dehiscence

 

Causes and Risk factors related to the Patient

Age

Increasing age is a risk factor for wound dehiscence.

 

Malnutrition

If you have any nutritional deficiency like anemia, hypoalbuminemia, vitamin deficiencies etc. it will result in poor wound healing that will in turn can cause wound dehiscence. Most importantly, vitamin c deficiency, zinc deficiency, protein deficiency can reduce wound healing.

 

Best Abdominal Exercises Post-Hernia Surgery: A Safe Recovery Guide

Best Abdominal Exercises Post-Hernia Surgery: A Safe Recovery Guide
Photo by Andrej Klintsy:

After hernia repair surgery, patients often wonder: When can I exercise again? What ab workouts are safe?

While strengthening your core is important for preventing recurrence, doing the wrong exercises too soon can cause re-injury.  

As a doctor facing these kinds of questions, I’ll guide you through:  

✔ When to start exercising after hernia surgery 

✔ The safest abdominal exercises for recovery

✔ Movements to avoid (they can re-open your incision!)

✔ A phased workout plan (weeks 1–12+)

By following this doctor-approved ab workout plan, you’ll rebuild strength without compromising your healing.

When Can You Start Ab Exercises After Hernia Surgery?

General Timeline 

Key rules:

1. Always follow your surgeon’s advice first!

2. Stop immediately if you feel pain at the incision site. 

When can you start abs exercises after hernia surgery - General work out plan

Phase 1: Gentle Core Re-Activation (Weeks 3–8)

 

Start with low-impact isometric exercises (no crunching or twisting!).  

1. Diaphragmatic Breathing

✅ How: Lie on your back, inhale deeply through your nose (let belly rise), exhale fully.  

✅ Why: Re-engages transverse abdominis (deep core muscle).  

2. Pelvic Tilts

✅ How: Lie on back, knees bent. Gently flatten lower back into floor (engage core).  

✅ Reps: 10x, 2 sets daily.  

3. Heel Slides

✅ How: Lie on back, slowly slide one heel away (keep core braced).  

✅ Avoid: If you feel pulling near the incision.  

4. Seated Marches

✅ How: Sit tall, alternate lifting knees slightly (no hunching!).  

✅ Goal: Improve circulation without strain.  

Phase 2: Progressive Strengthening (Weeks 8–12+)

Once cleared by your doctor, add these safe abdominal exercises:  

1. Dead Bug Exercise

✅ How: Lie on back, arms toward ceiling. Slowly lower opposite arm/leg (keep core tight).  

✅ Tip: Place a pillow under hips if needed.  

2. Modified Plank (Forearm or Wall)

✅ How: Start with wall planks (lean at 45°), progress to forearm planks (knees down).  

✅ Avoid: Full planks until 3+ months post-op.

3. Bird Dogs

✅ How: On hands/knees, extend opposite arm/leg (keep hips level).  

✅ Bonus: Improves balance + core stability.  

4. Standing Core Exercises

✅ Examples:  

- Standing knee lifts (hold a chair for balance).  

- Pallof press (use resistance band anchored to wall).  

Exercises to AVOID After Hernia Surgery

❌ Crunches/sit-ups as these increase intra-abdominal pressure.

❌ Heavy weightlifting (wait 3–6 months for deadlifts).  

❌ Twisting motions (Russian twists, oblique bends).  

❌ High-impact cardio (running, jumping – wait 12 weeks).  

Why?

These can strain the mesh/repair site and cause recurrence.  

FAQ: Your Top Questions Answered

1. When can I do sit-ups after hernia surgery?

Not for at least 3–6 months (if ever—opt for safer alternatives like dead bugs).  

2. Can I lift weights after hernia repair?

Light weights (5–10 lbs) at 8+ weeks; heavy lifting only after 6 months with surgeon approval.  

3. How do I know if I’m overdoing it?

Warning signs: Sharp pain, bulging at incision, or swelling. 

This means that your hernia has recurred. Hence, do not overdo your exercises and that’s a must!

4. Will exercise prevent another hernia?

Yes! A strong core reduces pressure on weak spots—but progress slowly.  You will not develop a strong core overnight. Isn’t it? Give it the time needed.

Sample 12-Week Post-Op Ab Workout Plan 

Here is a summary of what we have discussed. You can use the following sample 12 week post hernia operation ab work out plan.

Sample 12 week post hernia operation Ab workout plan

  

Final Tip: Listen to Your Body

Recovery varies—some patients resume light jogging at 8 weeks while others need 6 months for heavy lifting. 

Always prioritise proper form over intensity.

Bookmark this guide and share it with your physical therapist or surgeon to customise your plan. 

Good luck!

From Dr. Pasindu

Stay happy stay healthy!

 

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Hernia Surgery: Types, Recovery, and Prevention – A Surgeon’s Guide

Hernia Surgery: Types, Recovery, and Prevention – A Surgeon’s Guide
Photo by cottonbro studio:

A hernia occurs when an organ or fatty tissue pushes through a weak spot in the surrounding muscle or connective tissue. 

Common types include inguinal (groin), umbilical (belly button), hiatal (upper stomach), and incisional (resulting from a surgical scar) hernias. 

While some hernias cause minimal discomfort, others require hernia repair surgery to prevent serious complications like strangulation (loss of blood flow to the trapped tissue).  

In this comprehensive guide, we’ll cover:  

- Different types of hernia surgery (open vs. laparoscopic)  

- Recovery timeline after hernia repair

- How to prevent hernias from recurring  

- Risks and success rates

By the end, you’ll understand whether hernia surgery is right for you and how to ensure a smooth recovery.  

What Is a Hernia and When Is Surgery Needed?

A hernia doesn’t always require immediate surgery, but hernia repair surgery becomes necessary if:  

✔ The hernia is painful or growing

✔ It becomes incarcerated (stuck) or strangulated (a medical emergency)  

✔ Lifestyle changes and supportive garments no longer help

Ignoring a hernia can lead to severe complications, making timely surgical intervention crucial.

Types of Hernia Surgery

There are three primary surgical approaches, each with its own benefits and recovery process.  

1. Open Hernia Repair (Herniorrhaphy/Hernioplasty)  

A single large incision is made near the hernia site. The surgeon pushes the protruding tissue back into place and reinforces the weakened area with a synthetic mesh (hernioplasty) or stitches (herniorrhaphy).  

This is best for: Large or complex hernias.  

Recovery time is 2–4 weeks for light activities and 6–8 weeks for heavy lifting.  

2. Laparoscopic Hernia Repair (Minimally Invasive Surgery)

Small incisions are made, and a tiny camera (laparoscope) guides the surgeon to repair the hernia using mesh.  

Less post operative pain, smaller scars, and faster recovery (1–2 weeks) are the benefits of this procedure.

This way is ideal for recurrent hernias or bilateral (both sides) inguinal hernias.  

3. Robotic-Assisted Hernia Surgery

This is similar to laparoscopic surgery but performed with robotic precision for complex cases.  

Enhanced 3D visualisation is useful for the surgeon.

Recovery is Comparable to laparoscopic repair.  

Your surgeon will recommend the best type based on hernia size, location, and your overall health.

Hernia Surgery Recovery Timeline

First 24–48 Hours After Surgery

- Pain management is of prime importance. Prescription or OTC pain relievers would work.

- Activity: Rest, but walk short distances to prevent blood clots.  

- Diet: Start with liquids, then progress to soft foods.  

1–2 Weeks Post-Surgery

- Driving: Usually allowed after 1 week (if off strong pain meds).  

- Work: Desk jobs can resume in 1 week; manual labor may require about 4 weeks.  

- Avoid: Heavy lifting, straining, or intense exercise. Although it may feel too exaggerated, usually patients are advised not to lift a weight more than a cup of tea in this period.

3–6 Weeks Post-Surgery

- You can gradually return to your normal activities.  

- Physical therapy may help strengthen the abdominal muscles.  

- Follow-up visit to surgeon to check the wound healing progress.  

Long-Term Recovery

- Full recovery takes 3–6 months for strenuous activities.  

- Scar tissue softens over time.  

How to Prevent Hernia Recurrence

Even after surgery, hernias can return. Following these hernia prevention tips would reduce the recurrence rates.

1. Strengthen Your Core

- Practice low-impact exercises (e.g., swimming, Pilates).  

- Avoid sit-ups or heavy weightlifting initially.  

- Check out my article on Best abdominal exercises post hernia surgery: a safe recovery guide to see what are the safe ab exercises you can do post hernia surgery.

2. Maintain a Healthy Weight

- Excess weight increases abdominal pressure.  

3. Avoid Straining

- Use proper lifting techniques (bend at the knees, not waist).  

- Treat chronic coughs or constipation (they increase hernia risk).  

4. Follow Post-Op Instructions

- Wear an abdominal binder if recommended.  

- Attend all follow-up appointments.  

Risks and Complications of Hernia Surgery

While generally safe, potential risks of hernia surgery include: 

- Infection (redness, fever, pus – requires antibiotics).  

- Nerve damage (numbness or chronic pain).  

- Mesh rejection or adhesion (rare but may need revision surgery).  

- Recurrence (5–10% risk, higher without mesh).  

Choosing an experienced hernia surgeon minimises these risks.

What are the Non-Surgical Alternatives? (When Surgery Isn’t an Option)

For high-risk patients, alternatives include:  

- Watchful waiting (for small, asymptomatic hernias).  

- Truss (hernia belt) – temporary relief but not a cure.  

Most importantly it is noteworthy to remind you that these don’t fix the hernia—only surgery can fully repair it.

Frequently Asked Questions (FAQs)

1. How long does hernia surgery take?

- Open repair: 30–60 minutes.  

- Laparoscopic: 45–90 minutes.  

2. Will I need general anesthesia?

Most laparoscopic/robotic surgeries use general anesthesia; some open repairs use local anesthesia.  

3. When can I exercise after hernia surgery?

- Light walking: Day 1

- Gym/running: 4–6 weeks (with surgeon’s approval).  

4. How successful is hernia surgery?

90–95% success rate with mesh; slightly lower without.  

5. Can hernias heal without surgery?

No—they only worsen over time. Surgery is the only permanent fix.  

Final Thoughts: Is Hernia Surgery Right for You?

If you have a painful, enlarging, or trapped hernia, surgery is often the best solution. Modern techniques like laparoscopic and robotic hernia repair offer quicker recoveries and minimal scarring.  

Consult a general surgeon to discuss your options. Early intervention prevents complications like bowel obstruction or tissue death.  

Good luck!

From Dr. Pasindu

Stay happy stay healthy!

 

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