Re: Gallstones

Posted By HFHSM.D.-ym on November 10, 1998 at 13:51:14:

In Reply to: Gallstones posted by Chris Dyson on November 05, 1998 at 15:44:59:






Hello my mother is 66 yrs old and has just been diagnosed with mutiple small gallstones.. she is currently very inflamed in the lower abdomen. She also has a hernia on her digestive tract(sorry i dont have the medical term..hia is what it sounds like). She is also taking medication for heart problems.In conjunction, she had an operation in feb of 98 for herniated disc, at which time her lung had collapsed.(she was under anasthesia at the time)..My question for you would be, is it possible for her to treat the gallstones through a non-invasive technique even though she is in a progressed stage of the disease. Her surgeon said that this surgery must be done to take out the gallbladder. Her fears are of a reoccurance of  complications in the previous surgery, as well as concern of her heart condition. I would appreciate a prompt response..she has been urged to set up an appointment for the operation as soon as next week.. thankyou.....deeply concerned
Dear Chris,
In patients with biliary pain who have documented gallstones, the current treatment of choice is to surgically remove the gallbladder. This can be performed laparoscopically or with open cholycystectomy. Most surgeons will routinely perform laparoscopic cholecystectomy. In patients who are poor surgical candidates other nonsurgical treatments have been employed. None of these treatments have as good a track record as surgery and recurrence is possible.
Oral bile acid dissolution therapy with ursodeoxycholic acid (Ursodiol, Actigall) can be tried in patients with uncomplicated gallstone disease. The stones must not be calcified and should be less than 10 mm in diameter. The number of stones does not limit treatment with ursodeoxycholic acid as long less than half of the gallbladder volume is occupied by the stones. An oral cholecystogram needs to confirm patency of the cystic duct. With ursodeoxycholic acid, complete dissolution is achieved in 20-70% of patients, but it may take up to 2 years. Recurrence rates are about 50% within five years.
Extracorporeal shock wave lithotripsy (ESWL) can break up large stone fragments or dissolve smaller stones by using sound wave technology to destroy gallstones. Patients may be symptomatic but should have uncomplicated disease. An oral cholecystogram should be performed prior to treatment. The patient should only have one stone which is less than 20 mm in diameter. Sometimes this therapy is used in combination with oral dissolution therapy. In properly selected patients, studies have shown a 64% and 84% stone free interval at 6 months and 12 months respectively. Recurrence rates are 31% at five years.
An approach that has recently been abandoned is direct solvent dissolution therapy. In this method a catheter is placed into the bile ducts where a chemical is infused in order to dissolve gallstones.
I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or consultation. Always check with your personal physician when you have a question pertaining to your health.
If you wish to be seen at our institution please call 1-800-653-6568, our Referring Physicians Office and make an appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: gallstones