Acute cholecystitis is inflammation of the gallbladder, commonly caused by a gallstone blocking the cystic duct and disrupting the normal flow of bile. This can result in persistent upper abdominal pain, fever, nausea and vomiting, and may require prompt medical assessment. Following an acute episode, some patients may be considered for gallstones removal Singapore to reduce the risk of further gallstone-related problems. 

However, experiencing acute cholecystitis does not necessarily mean that every patient requires immediate surgery. Factors such as the severity of the inflammation, response to initial treatment, overall health and likelihood of recurrence can influence whether gallbladder removal is recommended. Understanding these factors can help patients make informed decisions about gallstones removal in Singapore.

What Happens During An Episode of Acute Cholecystitis?

Acute cholecystitis often develops when a gallstone becomes lodged in the cystic duct, causing bile to build up and triggering inflammation of the gallbladder. The most common symptom is sudden or persistent pain in the upper right or upper middle abdomen, which may sometimes spread to the right shoulder or back. Patients may also experience nausea, vomiting, fever or tenderness when the abdomen is examined.

When acute cholecystitis is suspected, a doctor may assess the symptoms and perform blood tests to look for signs of inflammation or changes in liver function. An abdominal ultrasound is commonly used to identify gallstones, gallbladder inflammation and related findings. Depending on the clinical situation, further imaging may be required. Prompt assessment is important because untreated inflammation can sometimes lead to complications such as infection, tissue damage or perforation of the gallbladder.

Why Gallbladder Removal May Be Recommended After Acute Cholecystitis

Treating an acute episode of cholecystitis can relieve inflammation and symptoms, but it does not remove the gallstones that caused the blockage. As a result, some patients may experience another gallbladder attack after the initial episode. Recurrent inflammation can also increase the risk of complications involving the gallbladder or bile ducts.

For patients who are suitable candidates for surgery, laparoscopic cholecystectomy may be recommended as a definitive treatment. This procedure removes the gallbladder containing the stones rather than simply removing individual gallstones. The decision depends on factors such as the severity of the acute episode, the patient’s general health, surgical risks and whether complications have occurred.

When Is Surgery Considered After The Acute Episode?

The timing of gallbladder surgery after acute cholecystitis depends on the individual clinical situation. For some patients, laparoscopic cholecystectomy may be considered during the same hospital admission once the diagnosis has been established and the patient is medically suitable for surgery. Early surgery can avoid waiting for another episode of gallstone-related pain or inflammation.

However, immediate surgery may not be appropriate for everyone. Doctors may first manage the acute inflammation with measures such as pain relief, intravenous fluids and antibiotics when indicated. The patient’s age, other medical conditions, severity of inflammation and response to initial treatment may all affect the timing. In some circumstances, surgery is planned after the acute inflammation has settled. A surgical assessment can help determine whether early or delayed gallbladder removal is more suitable.

What Does Gallstones Removal Singapore Usually Involve?

For patients who require surgery, gallstones removal Singapore commonly involves laparoscopic cholecystectomy, which removes the gallbladder containing the gallstones. Rather than removing individual stones, the gallbladder is removed because leaving it in place may allow further stones and gallstone-related symptoms to develop. The procedure is performed under general anaesthesia and typically involves several small abdominal incisions.

During laparoscopic gallbladder removal:

• A small camera is inserted through one of the abdominal incisions to view the gallbladder.
• Surgical instruments are inserted through the other small incisions.
• The gallbladder is carefully separated from the surrounding tissues and removed.
• The incisions are then closed and monitored during recovery.

Laparoscopic surgery is commonly used and generally involves smaller incisions than open surgery. However, the appropriate approach depends on the patient’s condition. Significant inflammation, scarring or other complications may sometimes make open surgery necessary or require conversion from laparoscopic to open surgery during the procedure.

What If A Gallstone Has Also Entered The Bile Duct?

Acute cholecystitis primarily involves inflammation of the gallbladder, but gallstones can sometimes move from the gallbladder into the common bile duct. This is known as choledocholithiasis and may require additional treatment. A blocked bile duct can interfere with the flow of bile and, in some cases, lead to jaundice, infection or inflammation of the pancreas.

Doctors may look for signs of a bile duct stone through blood tests and imaging such as ultrasound, magnetic resonance cholangiopancreatography (MRCP) or endoscopic ultrasound. If a stone is confirmed or strongly suspected, endoscopic retrograde cholangiopancreatography (ERCP) may be used to remove it.

The treatment approach may therefore involve:

• Gallbladder removal: Removes the gallbladder containing the stones and helps prevent further gallstone-related episodes.
• ERCP: Allows stones in the common bile duct to be removed without surgically opening the bile duct.
• Additional imaging: May be recommended when the presence or location of a bile duct stone is uncertain.

Managing bile duct stones is different from removing gallstones from the gallbladder, so the appropriate sequence of treatment depends on the patient’s findings and overall condition.

Conclusion

Acute cholecystitis can be an indication to reassess how gallstones are being managed, particularly when symptoms recur or complications develop. Gallbladder removal may provide a definitive treatment for suitable patients, but the timing and approach depend on the individual’s condition, test results and surgical risk. 

A consultation can help determine whether surgery is appropriate and what treatment plan may be suitable. Considering treatment for gallstones after an episode of acute cholecystitis? You can contact our doctor at:

Dr Lee Chin Li – Lee Surgery and Endoscopy | Colorectal Surgery | Gallbladder Surgery Singapore

6 Napier Rd, #04-16 Gleneagles Medical Centre, Singapore 258499

Phone: +65 6255 0720

https://www.leesurgery.com.sg/