​What kinds of symptoms do patients experience before receiving treatment?

A cholecystectomy is the surgical removal of the gall bladder, a pear-shaped sack positioned just below the liver. The gall bladder collects and stores bile, a digestive fluid produced by the liver that helps with digestion of food within the intestines. Sometimes, the bile forms into hard stones, called gallstones, which can block the flow of bile and cause recurring abdominal pain and jaundice. It is not fully known why gallstones form. Risk factors include being middle-aged, female, or overweight. Diabetes or a high fat diet can also increase the risk of developing stones.

​What is the impact on patients’ lives of living with these conditions?

Many people have gallstones that do not cause any symptoms or health issues. However, stones can block the drainage of the gallbladder and cause severe upper abdominal pain. The onset of the pain is unpredictable and can occur at any time of the day or night. If the stones continue to block the flow of bile, the gallbladder can become inflamed and infected. This condition is called cholecystitis and requires emergency surgery.

What cultural or regional factors affect the treatment of these conditions?

This treatment is necessary and has no historical, cultural, or regional significance.

What does the treatment process look like?

A cholecystectomy is performed under general anesthesia. The surgery can be done via an incision in the upper abdomen or laparoscopically (a telescopic camera inserted into the abdomen). Open cholecystectomies are more common in the Philippines due to lack of training in the laparoscopic technique. During an open cholecystectomy, the surgeon makes a six-inch incision in the upper right abdomen below the ribs. The muscle and tissues are pulled back to reveal the liver and gallbladder. The surgeon then removes the gallbladder. The bile duct is checked to ensure that no additional stones remain. The incision is sutured, and the patient is taken to the recovery area until stable. During a laparoscopic cholecystectomy, the surgeon makes four small incisions in the abdomen. A tube with a tiny video camera is inserted into the abdomen through one of the incisions. The surgeon watches a video monitor in the operating theater as special surgical instruments are inserted through the other incisions in the abdomen to enable removal of the gallbladder.

What is the impact of this treatment on the patient’s life?

After the gallbladder is removed, the patient will no longer experience recurring pain. Some patients may experience minor digestive issues, such as diarrhea, but these symptoms usually resolve with time.

What potential side effects or risks come with this treatment?

This type of surgery is relatively common, and most patients experience very good outcomes. Occasionally, bleeding and infection can occur after surgery. Sometimes the nearby structures, such as the bile duct, can be damaged.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

Surgery is available in most public hospitals throughout the Philippines. However, even with government health insurance, there are still significant out-of-pocket expenses that make surgery inaccessible to very poor patients. Many patients will take natural remedies from traditional healers or wait until symptoms are very severe before seeking medical attention.

What are the alternatives to this treatment?

Gallstones that do not cause pain can be monitored and do not require surgery. The patient is advised to avoid meals with high fat content. However, if the gallstones cause frequent pain or complications, surgery is the only appropriate treatment. Medications must be taken for long periods and are often ineffective.