Thousands of people suffering agonising gallstones could benefit from a two-in-one procedure to quickly cure the condition.
Gallstones are solid particles that sometimes form in the gallbladder, a pouch-like organ sitting in the liver.
These ‘stones’ can become trapped in the duct which links the gallbladder with the rest of the gut, causing excruciating pain, nausea and jaundice.
Until now, some patients had to go through two separate procedures, weeks apart, firstly to have the lodged, pea-sized balls taken out and, later, the gallbladder removed.
But now, surgeons at London North West University Healthcare NHS Trust are using lasers to blast away the stones before taking out the organ in a single procedure.
Surgeons at London North West University Healthcare NHS Trust are using lasers to blast away the stones before taking out the organ in a single procedure
The one-hour keyhole operation has a lower risk of complications than traditional methods, so spares patients from a potentially lengthy recovery time, according to experts.
Alberto Martinez-Isla, a consultant surgeon at London North West University Healthcare NHS Trust, explains: ‘When gallstones get trapped they can cause patients real discomfort and lead to life-threatening problems with other organs in the digestive system.
‘The standard treatment involves at least two hospital visits and multiple days of recovery.
‘This new, single-stage procedure is better for patients, requiring just a one-day hospital stay.’
The gallbladder is about the size of a small purse and sits under the liver in the upper abdomen.
It stores bile, a substance made in the liver which aids fat digestion.
Gallstones are thought to develop when there is an imbalance in the chemical make-up of bile, but it is unclear exactly what causes this.
‘Stones’ can become trapped in the duct which links the gallbladder with the rest of the gut, causing excruciating pain, nausea and jaundice
One in ten adults in the UK has them, with women, the over 40s and obese and overweight people most likely to be affected.
Most will not experience symptoms. However if a stone becomes trapped in the opening of the gallbladder, it can trigger sudden, intense pain in the abdomen.
Some people with gallstones also develop severe complications. The gallbladder can become inflamed, resulting in persistent pain, jaundice and a high temperature. Acute pancreatitis can also occur.
Medication is not prescribed very often as it doesn’t work for most people. The most effective treatment is removal of the gallbladder. The organ is not essential and people can live a normal life without one.
However, studies suggest up to 18 per cent of people who undergo surgical removal of this pouch will have at least one stone still trapped in their bile duct, the tube that attaches the gallbladder to the intestines. This can cause the pancreas to become inflamed and prove fatal – which is why the stones must be removed first.
This is usually done during an endoscopic procedure, which involves inserting a flexible tube through the mouth and down into the stomach.
A cut is made at the opening of the bile duct and the trapped stones are cleared. The gallbladder is taken out a few weeks later in a separate operation. But in the gap between procedures, some patients suffer another attack of gallstones, which then need to be cleared again, further delaying recovery.
WHAT ARE GALLSTONES?
Gallstones are lumps of sold material that form in the gallbladder.
In the UK, up to one in 10 adults have the condition. It affects around 15 per cent of people in the US.
Gallstones can resemble grains of sand or large pebbles.
They are formed from chemicals in bile and can consist of just cholesterol, a mixture of calcium and a pigment from red blood cells, or a combination of the two.
Gallstones have been linked to high-cholesterol diets, as well as liver damage and fasting.
Most people are unaware they have gallstones.
The most common symptom is abdominal pain, which can last up to eight hours and be severe.
This may be mistaken for a heart attack.
Pain occurs due to the gallbladder trying to expel the stones.
If gallstones have been discovered via a scan for something else and are not causing symptoms, they are often left without treatment.
Gallbladder inflammation may require antibiotics to be administered in hospital.
Severe symptoms may lead to people having the organ removed.
The gallbladder, which is involved in digestion, is not essential for life.
Source: British Liver Trust
The endoscopic procedure can also damage the bile duct and cause bile to leak into the abdomen afterwards.
Now, using lasers, surgeons can blast large, hard-to-reach gallstones into small pieces – and take out the gallbladder – in one go.
‘The new lasers have made it much easier to clear stones in the bile duct – even very large ones which would otherwise be extremely hard to remove,’ Mr Martinez-Isla says. ‘Avoiding the endoscopic procedure also reduces the risk of complications. This technology will help more and more patients have their gallstones treated, and gallbladder removed, in one procedure.’
The procedure – known as laser assisted bile duct exploration by laparoendoscopy, or LABEL – is carried out under general anaesthetic. Five tiny incisions are made on the patient’s stomach and a scope – a small tube containing a 3mm-wide camera – is inserted through one into the cystic duct, which joins the gallbladder and bile duct.
A laser fibre is then threaded through a channel of the scope and the instrument is moved into the bile duct to locate the trapped stones. Short bursts of energy are emitted to blast the stones into tiny pieces which are retrieved in a basket.
Finally, the gallbladder is cut from the bile duct and removed.
A clip is put in place to close up the end of the bile duct at the end of the operation.
Patients are generally well enough to go home the next day.
Margaret O’Sullivan, 83, from Harrow, was left in agony and lost three stone in weight when gallstones became lodged in her bile duct in March last year.
‘It got so bad I didn’t care if I lived,’ the mother-of-four says.
‘I only had to eat a mouthful of food and I’d get the most excruciating pain in my stomach that would last for days on end.
‘It got so bad at one stage that I couldn’t even drink a cup of soup and the bouts would last round the clock, several days at a time. I stopped eating to avoid the pain.’
She underwent the procedure in April, was home three days later and is now pain-free.
Luckily, her appetite has fully returned. ‘I’m tucking into all those things I couldn’t eat before – like pate,’ she said. ‘It’s heaven.’