Gallstones are hardened deposits that form in the gallbladder, the pear-shaped organ that stores bile from the liver used to digest fats. An individual can develop one or more gallstones at a time. Most gallstones are very small and do not cause any symptoms or require treatment. Larger ones, however, can cause an obstruction in the bile duct, causing intense abdominal pain. In such cases, gallstones removal is recommended.

What Causes Gallstones to Form?

Gallstones are thought to be caused by a chemical imbalance of bile that is stored in the gallbladder. This may be due to one of three reasons:

  • There is too much cholesterol in the bile.
  • There is too much bilirubin in the bile. Bilirubin is a yellow-orange pigment that is naturally produced during the breakdown of red blood cells.
  • The gallbladder does not empty normally, causing the bile inside to become more concentrated and eventually harden.

Being obese or overweight, and having a sedentary lifestyle and high-fat or high-cholesterol diet can also increase one’s risk of developing gallstones.

Signs & Symptoms of Gallstones

Most gallstones do not cause symptoms until they are large enough to block a bile duct; in which case, the following may be observed:

  • Sudden intense pain in the upper right part of the abdomen that can last from 15 minutes to a few hours
  • Pain between the shoulder blades and in the right shoulder
  • Nausea and vomiting
  • Abdominal bloating or gas
  • Indigestion

Immediate medical attention from a gallstones surgeon is required if symptoms such as persistent pain for several hours, fever and chills, dark urine and jaundice (yellow eyes or skin) are present.

How are Gallstones Treated?

Small gallstones that do not cause any symptoms will usually resolve on their own. However, if symptomatic, the following treatments may be recommended:
This type of gallstones surgery in Singapore involves the removal of the gallbladder. A cholecystectomy is the most common and effective way to treat and prevent gallstones, and alleviate their symptoms. It can be performed via traditional open surgery or through laparoscopic (minimally invasive) surgery.
This procedure involves cutting the sphincter muscle between the pancreatic and common bile ducts, after which a catheter is used to remove gallstones and other obstructions in the gallbladder.
For smaller gallstones or in cases where surgery is not suitable for the patient, medicines may be prescribed. These medicines work by using bile acids to break up gallstones, allowing them to be naturally passed from the body easily.
Dr Wong Jen San
Consultant Hepatobiliary & Pancreatic Surgeon
MBChB (UK), MMed (S’pore), Msc (S’pore), FRCS (Edin), FAMS

Upon graduating from the University of Leicester and completing his basic surgical training in the United Kingdom, Dr Wong went on to complete advanced training in Singapore before embarking on his HMDP clinical fellowship in Japan—specializing in living donor liver transplantation.

Prior to establishing his own practice, Dr Wong was previously a consultant with the Department of Hepatopancreatobiliary & Transplant Surgery at SGH, an adjunct assistant professor at the Duke-NUS Graduate Medical School and a visiting consultant at the National Cancer Centre Singapore.

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The Hepatobiliary-Pancreatic System
is a Complex and Intricate One
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