Gallbladder-associated diseases are becoming increasingly common in th subcontinent, and North India has become the epicenter for gallbladder cancer with the largest number of cases in the world.

Gallstone diseases are among the most recurrent and frequent diseases delineated in India and neighbouring countries and recent reports have suggested that the North India was developing as gallbladder cancer prone area in the world. Renowned gastro surgeon Dr KB Jain has said that gallstone cancer has became a common problem in the country.

Dr Jain also said that research was underway to underline the causes of gallstone as researches have mixed bag of opinion for that. Major reasons behind the formation of gallstones could be excess of cholesterol, excess of bile fluid and concentration of bile in gallbladder due to improper passing of bile fluid. “Lifestyle, fast foods, lack of physical activity and fatty diet are some reasons creating the problems in abdomen including gallstones. Excess use of oil increases cholesterol which led to gallstone formation commonly” Dr Jain said adding that obesity can raise the cholesterol level and also make it harder for the gallbladder to empty completely and make gallstones.

“Other reasons behind the formation of gallstone could be losing weight quickly, diabetes, pregnancy, some hormone therapy and too much fasting” he said adding that gallstones range in size from as small as a grain of sand to as large as a golf ball. Some people develop just one gallstone, while others develop many gallstones at the same time.

Speaking about the symptoms of gallstones, Dr Jain said in many cases gallstones cause no signs or symptoms but common symptoms which indicate gallstone problems are pain in upper belly and upper back, nausea vomiting and digestive problems. If a gallstone lodges in bile duct and cause a blockage then sudden and rapid intensifying pain in the upper right portion of abdomen can occur, he pointed out.

Dr Jain said for diagnose the gallstone problem doctors recommend an abdominal ultrasound and computerised tomography (CT) scan to create pictures of gallbladder. These pictures can be analysed to look for the signs of gallstones, he said adding that in complicated condition when a gallstone cause blockage hepatobiliary iminodiacetic acid (HIDA) scan, magnetic resonance imaging (MRI) or endoscopic retrograde cholangiopancreatography (ERCP) tests can be suggested. Some blood tests can also be suggested to determine infection, jaundice, pancreatitis or other complications caused by gallstones, he said.

“Recent reports have suggested that gallstones are the most common risk factor for gallbladder cancer. At least 3 out of 4 people with gallbladder cancer have gallstones when they are diagnosed. Though most people with gallstones never develop gallbladder cancer” Dr Jain said adding that searches say that North India is developing as gallbladder prone area in the world. Gallbladder cancer does not usually cause signs or symptoms until later in the course of the disease, but sometimes symptoms can appear sooner and lead to an early diagnosis. If the cancer is found at an earlier stage, treatment might be more effective.

He said treatment for gallstones depends on symptoms and the results of diagnostic testing. Doctor may recommend you be alert for symptoms of gallstone complications, such as intensifying pain in your upper right abdomen. Treatment options for gallstones include surgery to remove the gallbladder and medications to dissolve gallstones.

Also, if someone has not any symptoms, "active monitoring" is often recommended, he said adding that immediate treatment is not required but if any symptoms occurs doctor should be consulted immediately as ignorance can develop more complications like scarring of the liver, diabetes and other issues including gallbladder cancer. If symptoms are more severe and occur frequently, surgery to remove the gallbladder is usually recommended Dr Jain said adding that gallbladder isn't an essential organ and anyone can lead a perfectly normal life without one. Some people may experience symptoms of bloating and diarrhoea after eating fatty or spicy food. If certain foods do trigger symptoms, you may wish to avoid them in the future.

Speaking about surgery Dr Jain said usually keyhole surgery also known as laparoscopic cholecystectomy is recommended to remove gallbladder. During a laparoscopic cholecystectomy, three or four small cuts are made in your abdomen. Then a laparoscope (long thin telescope with a tiny light and video camera at the end) is inserted through one of the cuts in abdomen which allows surgeon to view the operation on a video monitor and surgeon will then remove gallbladder using special surgical instruments.

Laparoscopic cholecystectomies are usually performed under a general anaesthetic, which means patient will be sleeping during the procedure and won't feel any pain while it's carried out, he said adding that operation takes 60-90 minutes and patient can usually go home the same day. Full recovery typically takes around 10 days, he pointed out.

If it's thought there may be gallstones in the bile duct, an X-ray or ultrasound scan of the bile duct is also taken during the operation. If gallstones are found, they may be removed during keyhole surgery. If the operation can't be done this way or an unexpected complication occurs, it may have to be converted to open surgery.

In special cases when laparoscopic cholecystectomy cannot be performed then open cholecystectomy may be recommended. Special condition includes third trimester (the last three months) of pregnancy, extremely overweight and an unusual gallbladder or bile duct structure that makes a keyhole procedure difficult and potentially dangerous. Open surgery is just as effective as laparoscopic surgery, but it does have a longer recovery time and causes more visible scarring. Most people have to stay in hospital for up to five days and it typically takes six weeks to fully recover.

“One can lead a perfectly normal life without a gallbladder. Liver will still make enough bile to digest food but, instead of being stored in the gallbladder, it drips continuously into digestive system” Dr Jain said. People may be advised to eat a special diet before surgery, but it doesn't need to be continued afterwards. Instead, one should aim to have a generally healthy, balanced diet, he added. Besides some people experience problems such as bloating or diarrhoea after surgery, although this usually improves within a few weeks.