Gallstones are formed as a result of precipitation of cholesterol and bile salts from the bile. They are usually yellow-green and are made primarily of hardened cholesterol. They account for about 80% of gallstones. 

Scientists believe cholesterol stones form when bile contains 

• too much cholesterol, 
  
• too much bilirubin,
  
• not enough bile salts, or possibly
  
• when the gallbladder does not empty as it should for some other reason.
  

These types of gallstones are small, dark stones made of bilirubin. The exact cause is not known. They tend to develop in people who have 

• cirrhosis, 
  
• biliary tract infections, and 
  
• hereditary blood disorders such as sickle cell anaemia in which too much bilirubin is formed.
  

As gallstones are related to excess excretion of cholesterol, other risk factors or causes associated with gallstones are:

• Obesity - Especially in women.
  
• Oestrogen - Excess oestrogen from pregnancy, hormone replacement therapy, or birth control pills. Women between 20 and 60 years of age are twice as likely to suffer from gallstones than men.
• Family history of gallstones
• Rapid weight loss - As the body metabolizes fat during rapid weight loss, it causes the liver to secrete extra cholesterol into bile.
  

Cholecystitis

Calculous cholecystitis is where gallstones obstruct the outlet of the gallbladder causing inflammation of the walls of the gallbladder. This condition can lead to swelling, pain and sometimes infection.

Acalculous Cholecystitis

When inflammation of the gallbladder occurs without the presence of gallstones it is referred to as acalculous cholecystitis. This gallbladder condition tends to occur with gallbladder injury caused as a result of:

• surgery, 
  
• prolonged fasting, 
  
• critical illnesses or 
  
• when a problem with the immune system occurs.
  

Treatments depend on the type of gallbladder disease.

Where patients experience gallbladder pain episodes, an operation called cholecystectomy is often recommended. A cholecystectomy involves the surgical removal of the gallbladder.

Fortunately, the gallbladder is an organ you can live without. Gallbladder removal results in complete recovery and the majority of patients do not require a specific diet after the surgery.

Gallbladder removal is indicated when:

• gallstones start causing pain-even after only one attack of pain.
  
• gallstones cause complications such as jaundice, or cholangitis or pancreatitis.
  
• gallstones are asymptomatic in certain patients, in particular immunosurpressed patients.
  

Cholecystectomy - gallbladder removal - is performed laparoscopically through 4 small incisions.

The main benefit of this laparoscopic procedure is that it is a minimally invasive procedure. Minimally invasive surgery means "Less Pain" and "Faster Recovery".

There is less incisional pain that occurs with standard abdominal surgery, so the recovery time is much quicker. Also, the scars on the abdomen are much smaller when compared with traditional surgery. Laparoscopic surgery is now the standard method for removing the gallbladder.

A Laparoscopic Cholecystectomy procedure involves 

• making four small incisions in the abdomen
  
• Surgical instruments and a miniature video camera are inserted into the abdomen
  
• the camera sends a magnified image from inside the body to a video monitor. 
  
• as Dr Hatzifotis views the organs and tissue he uses the instruments to carefully separate the gallbladder from the liver, ducts, and other structures. 
  
• An x-ray of the bile duct is taken to confirm the anatomy and identify if there are any gallstones that have moved into the bile duct.
  
• If there are stones in the bile duct they can either be removed during the laparoscopic operation.
  

Other complications associated with gallstones and the gallbladder may include 

• Pancreatitis - as a result of a gallstone that moves down the bile duct to block the outlet of the pancreas. 
  
• Cholangitis - Cholangitis is an infection of the common bile duct due to a gallstone obstructing the bile duct.
  

If left untreated the gallbladder can become severely inflamed, causing some of the tissue to die and decay resulting in gallbladder rupture or septicaemia (blood poisoning), a life-threatening condition. In some cases, an abnormal channel may develop between the gallbladder and gut due to the inflammation.

There are very few instances when laparoscopic surgery is not preferable to conventional surgery for cholecystectomy.

The only real contraindication is if there is a strong suspicion that the gallbladder may have developed cancer.

Like any abdominal surgery, Laparoscopic Cholecystectomy carries some risks. Even though infrequent, they are no more than most other general surgery procedures.

Complications are rare and may include: 

• Bleeding (1/1000 cases) & infection may occur but is rare.
  
• Standard open abdominal surgery if the gallbladder can not be safely removed laparoscopically occurs in less than 1% of cases.
  
• Very rarely Injury to the bile ducts (1/1000 cases), blood vessels (1/1000 cases), or intestine can occur, requiring corrective surgery.