Aging Begins at 30

LBJ's Operation and Yours

President Johnson was proud of showing his gallbladder operation scar to photographers.

Your doctor has several methods of treatment available for gallstone problems He or she can dissolve the stones, remove the bile stones through a long endoscope passed into the gut via the mouth or directly through the skin. However, in the majority of cases the gallbladder can be removed through a small incision using a laparoscope or by an open abdominal operation or shatter the stones by a giant shock wave generator called a lithotripsy or stone grinder in Greek. Lithotripsy can be followed by biliary colic when the shattered stones are passed out into the intestine. The fragments which remain must be dissolved by taking bile salts. Because this procedure is applied to a small fraction of patients (15-20%), requires bile therapy and has the potential of recurrence of stones, it has been almost completely replaced by the newer laparoscopic technique.

You can live a long time with a gallstone without symptoms, and over a 20 year period only 10% need operations. With symptoms, however, something needs to be done.

There is a method of dissolving the stones by the use of dried bear bile or yu-tan which has been an Oriental medicine for over 1,000 years. Ursodiol (urso means bear) (or Actigall) can dissolve 30% of gallstones up to an inch across and is better than its predecessor chenodiol (Chenix 1987) but it takes many months. With the present medications, unfortunately, up to half may recur in 5 years but these can be treated again in the same way. Perhaps someone will invent a new medication called tyrannosaurus-diol to take care of the larger stones! Another gallstone dissolver cannot be taken orally so moctanin (or MTB ether) has to be given via a catheter through the skin or via an endoscope into the gallbladder. These dissolving techniques may cause diarrhea and can raise your LDL cholesterol.

Gallbladder surgery is the second most common surgery after Caesarean section. Most commonly, it is done with a laparoscope introduced in France in 1987 with a case fatality rate of under 1%. The patient is usually out of the hospital in one day and back at work in one week.

Complications are a tendency to reform gallstones with or without a gallbladder. Age, cirrhosis, kidney failure, and possibly diabetes make the treatment outlook worse. Deaths after non-urgent gallbladder removal are very rare, but morbidity after emergency surgery is 15%.

You too, like President Johnson, may lose your gallbladder.

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See related Patient Topics Digestive System or Gallbladder and Bile Duct Diseases.

See related Provider Topics Digestive System or Gallbladder and Bile Duct Diseases.

All contents copyright © 1992-2004 the Author(s) and The University of Iowa. All rights reserved.

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