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Gallbladder Treatment in Singapore

Dr Thng Yongxian

Gallstones Doctor
MBBS • MMed • MRCS (IRE) • FRCSED • FAMS

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What Are Gallbladder Stones

Gallstones, also known as cholelithiasis, are small, hard deposits that form in the gallbladder, a small organ situated beneath the liver. 

 

Gallbladder stones form when the chemical composition of bile becomes unbalanced, causing its components to crystallise and harden.

 

The stones are made up of hardened cholesterol or pigments, such as bilirubin, and can range in size from a tiny grain of sand to as large as a golf ball. Two main types occur: cholesterol stones and pigment stones.

 

In many cases, gallstones do not cause any symptoms and do not require treatment. However, if a gallstone blocks the flow of bile through the bile ducts, it can cause persistent pain, inflammation, or infection of the gallbladder. 

 

In some cases, a stone may migrate into the bile duct, a condition known as choledocholithiasis, or block the pancreatic duct, leading to more serious complications that require a doctor’s attention.

Types of Gallstones

Cholesterol Gallstones

  • Composition: Predominantly made of hardened cholesterol, these stones account for around 80% of all gallstone cases. They also contain other substances found in bile.
  • Appearance: They are usually yellow-green and can vary in size and shape.
  • Formation: These stones form when bile contains too much cholesterol and not enough bile salts.

Pigment Gallstones

  • Composition: Composed mainly of bilirubin, pigment stones are formed from the breakdown products of red blood cells.
  • Appearance: These stones are smaller and darker, typically black or dark brown.
  • Formation: Conditions that cause increased red blood cell destruction, such as sickle cell anaemia, can lead to elevated bilirubin levels in bile, resulting in pigment gallstones.

Causes of Gallstones

The formation of gallstones is influenced by several factors, including:

Chemical Imbalance in Bile

The primary cause of gallstone formation is an imbalance in the chemical composition of bile, a digestive fluid produced by the liver. This imbalance can lead to the crystallisation of bile components, forming gallstones.

 

For cholesterol stones, the imbalance involves an excess of cholesterol in bile, while for pigment stones, it is an excess of bilirubin.

 

This imbalance can lead to the crystallisation of bile components, forming gallstones.

Gallbladder Function

The gallbladder’s main role is to store and concentrate bile. If the gallbladder does not empty completely or regularly, the resulting concentrated bile may increase the risk of gallstone formation.

Other Risk Factors

  • Gender and Age: Women, especially those over 40 years old, have a higher risk of developing gallstones due to hormonal differences that may affect bile composition.

  • Obesity: Obesity can increase cholesterol in bile and reduce gallbladder movement, contributing to gallstone formation.

  • Diet: A diet high in fat and cholesterol and low in fibre can increase the risk of gallstones.

  • Family History: A genetic predisposition to gallstones can be inherited, making family history a significant risk factor.

Signs and Symptoms of Gallstones

Asymptomatic Gallstones

Many individuals have gallstones without symptoms. These are often discovered incidentally during imaging tests performed for other conditions. In the absence of symptoms, intervention from a gallbladder specialist is generally not required.

Symptomatic Gallstones

When symptoms do occur, they often include:

  • Sudden and intense pain in abdomen: Also known as biliary colic, pain in the upper right or upper middle abdomen is one of the most common symptoms of gallstones. The pain can last from a few minutes to several hours and may radiate to the right shoulder or between the shoulder blades.

  • Nausea or vomiting: These symptoms often accompany the pain from biliary colic, indicative of digestive distress when a gallstone causes an obstruction.

  • Indigestion: This often presents as discomfort or a feeling of fullness after eating, particularly following meals high in fat.

  • Jaundice: If a gallstone blocks the bile duct, bile can build up in the liver, causing yellowing in the skin and eyes from jaundice.

  • Fever and chills: These may indicate infection or inflammation of the gallbladder.

  • Other symptoms: Some patients also experience belching, abdominal bloating, or clay-coloured stools.

If gallstones migrate through the bile duct and block the pancreatic duct, they can cause inflammation of the pancreas (pancreatitis).

 

When jaundice or fever develops alongside abdominal pain, timely assessment by a gallbladder doctor is advisable.

Diagnosis of Gallstones

The diagnosis of gallstones involves a combination of clinical assessment, imaging studies, and laboratory tests:

Ultrasound

This is the primary imaging technique used to detect gallstones. It is non-invasive and highly effective at identifying stones within the gallbladder.

Computed Tomography Scan (CT Scan)

CT scans provide detailed images of the abdominal area, helping to diagnose complications or rule out other causes of abdominal pain.

Magnetic Resonance Cholangiopancreatography (MRCP)

MRCP is a specialised MRI technique that can visualise the biliary and pancreatic systems, providing valuable insights for diagnosing conditions like gallstones.

Endoscopic Ultrasound (EUS)

EUS combines endoscopy and ultrasound to provide detailed images of the digestive tract and surrounding organs, assisting a gallbladder specialist in diagnosing gallstones or their complications.

Blood Tests

Blood tests assess liver function and detect signs of inflammation or infection, which can provide crucial indicators for diagnosing gallstones.

Intraoperative Cholangiogram

A cholangiogram (an imaging test using X-rays and contrast dye) may also be performed during surgery to identify stones present in the bile ducts. If gallbladder stones are found, the surgeon can remove them at the same time, or arrange a follow-up ERCP procedure to address them.

Get an Accurate Diagnosis and Specialised Treatment for Gallstones

Consider consulting our fellowship-trained gallbladder specialist to receive a precise diagnosis and explore gallstone treatment and surgery options in Singapore.

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Treating Gallstones

Watchful Waiting

  • This approach is often recommended for asymptomatic gallstones, involving monitoring without immediate intervention. This is because the risks of intervention may outweigh the benefits if symptoms are absent. 

Medications

  • Ursodeoxycholic acid may be prescribed to dissolve small cholesterol gallstones, working by reducing cholesterol production and synthesis.
    However, this option can take several months to years to work, with stones potentially recurring. As side effects may occur, consulting a gallbladder doctor is advisable to determine suitability.

Non-Surgical Procedures

  • Endoscopic Retrograde Cholangiopancreatography (ERCP) is a procedure using an endoscope to access, break up, and remove gallstones lodged in the bile duct. While effective, potential risks include allergic reactions and inflammation of the pancreas.

Surgical Treatments

Surgery is typically recommended when symptoms develop or complications arise, such as infection, bile duct obstruction, or inflammation of the pancreas.

  • Laparoscopic Cholecystectomy: This is a surgical procedure where several small incisions are made in the abdomen to remove the gallbladder using a laparoscope and surgical instruments. The surgeon operates while viewing a live video feed of the abdomen. Clips are applied to the artery supplying the gallbladder and its duct, after which the gallbladder is carefully detached and removed. The procedure is minimally invasive, involving less post-operative pain and a shorter recovery time.

  • Open Cholecystectomy: This is a traditional surgery in which a single, larger incision is made in the abdomen to access and remove the gallbladder. While laparoscopic cholecystectomy is the preferred approach, difficulties accessing the gallbladder or bile duct complications may necessitate a conversion to an open procedure during the surgery. Open cholecystectomy may also be planned from the outset where the gallbladder is severely diseased.

Extracorporeal Shock Wave Lithotripsy (ESWL)

  • ESWL uses shock waves to break up gallstones into smaller pieces that can pass more easily. However, it is not as commonly used due to limited effectiveness and high recurrence rates.

Complications Associated with Gallstones

In some cases, gallstones can lead to several complications:

  • Cholecystitis: This involves inflammation of the gallbladder, typically occurring when a gallstone blocks the cystic duct, leading to pain and potential infection. Acute cases require immediate medical attention by a gallbladder inflammation specialist.

  • Pancreatitis: If a gallstone blocks the pancreatic duct, the pancreas may become inflamed. Patients often experience severe abdominal pain and require urgent medical attention from a pancreatitis doctor.

  • Cholangitis: This is a serious infection of the bile ducts, usually resulting from gallstone obstruction, and can cause fever, jaundice, and abdominal discomfort.

  • Gallbladder Cancer: Although rare, a history of gallstones, particularly large ones, is considered a risk factor for gallbladder cancer.

Complications from gallbladder surgery are uncommon but can include infection at the incision site, bleeding, or unintentional injury to surrounding organs, such as the bile ducts, blood vessels, or bowel.

 

Some patients, particularly those who are overweight, may also develop a hernia at the incision site following surgery.

 

In fewer than 1% of cases, a bile duct injury may require further surgery to repair. There is also a small risk (fewer than 5%) of undetected stones remaining in the bile duct, which may require a follow-up ERCP procedure.

Post-Surgery Care For Gallstones

Gallbladder removal is a significant abdominal procedure, and some degree of postoperative pain, nausea, or vomiting may occur. However, most patients undergoing laparoscopic surgery are discharged on the same day or the day after the operation.

 

Those who undergo an open procedure may need to stay in hospital for a few days longer.

 

Recovery varies between individuals. Most patients can return to work within seven days after a laparoscopic cholecystectomy. While some may experience abdominal bloating or increased bowel frequency in the weeks following surgery, both typically resolve within a couple of months.

How Much Does Gallbladder Surgery Cost in Singapore

The surgeon’s fee for gallbladder removal (cholecystectomy) in Singapore ranges from $6,000 to $8,400, excluding hospital, anaesthetist, and consumable fees. These benchmarks are set by the Ministry of Health and exclude GST. 

 

Final costs depend on procedure type, case complexity, and hospital choice. Contact us for a detailed cost estimate.

Dr Thng Yongxian

Senior Consultant

HEPATOPANCREATOBILIARY & GENERAL SURGEON

MBBS (SG) • MMed (Surg) • MRCS (Ire) • FRCSEd (Gen) • FAMS (Surg)

Dr Thng Yongxian is a fellowship-trained Hepatopancreatobiliary & General Surgeon who has performed over 6000 surgical procedures.

  • Bachelor of Medicine & Bachelor of Surgery
  • National University of Singapore
  • Membership of the Royal College of Surgeons, Ireland
  • Master of Medicine, General Surgery, Singapore
  • Fellow of the Royal College of Surgeons, Edinburgh
  • Fellow of the Academy of Medicine, Singapore

Dr Thng Yongxian is a fellowship-trained Hepatopancreatobiliary (HPB) and General Surgeon with extensive experience in gallbladder surgery. He offers a wide range of options for gallstone disease treatment, including minimally invasive gallbladder surgery and complex laparoscopic gallbladder surgery. Over his career, he has performed numerous procedures, including standard cholecystectomy for gallbladder disease management.

 

He first honed his subspecialty expertise in HPB surgery at the Department of Hepatopancreatobiliary Surgery, Singapore General Hospital, before completing a clinical fellowship in minimally invasive HPB laparoscopic surgery at Seoul National University Hospital in South Korea. His surgical practice spans public institutions, such as the National University Health System, and private hospitals, including Mount Elizabeth, Gleneagles, and Mount Alvernia Hospital.

 

Dr Thng has been instrumental in advancing HPB surgery excellence in Singapore, pioneering his hospital’s laparoscopic HPB programme. Notably, he was a member of the Ministry of Health (MOH) Laparoscopic Cholecystectomy Clinician workgroup for Value-Driven Care (VDC), demonstrating his commitment to surgical standards in gallbladder care. His surgical techniques have been featured on live national television and presented at international surgical conferences.

Areas of Expertise

  • Hepatopancreatobiliary (HPB) Surgery Specialisation: Applying specialist HPB knowledge to gallbladder and bile duct conditions, ensuring a deep understanding of the complex anatomy connecting the liver, pancreas, and gallbladder during cholecystectomy.

  • Gallbladder Disease Management: Providing thorough assessment and gallstone disease treatment for patients in Singapore. This involves a detailed evaluation to determine the most appropriate treatment path, whether monitoring or surgical intervention.

  • Advanced Laparoscopic Surgery: Proficient in laparoscopic gallbladder surgery, including complex laparoscopic gallbladder surgery and standard cholecystectomy. Minimally invasive techniques may result in less post-operative pain and a faster return to normal activities.

  • Focus on Patient Safety: Employing precise surgical techniques to protect the bile duct and surrounding organs, reducing the risk of complications during cholecystectomy.

  • Management of Complex Cases: Experience with complex presentations, including acute cholecystitis, Mirizzi syndrome, prior abdominal surgeries, and bailout techniques.
Professional Appointments

  • Former Clinical Lead, HPB Division, National University Health System (NUHS)

  • Member, Ministry of Health (MOH) Laparoscopic Cholecystectomy Clinician Workgroup for Value-Driven Care (VDC)
CONSULT DR THNG YONGXIAN

Prevention and Management of Gallstones

Preventing the formation of gallstones may not always be possible, but some measures can reduce the risk.

  • Healthy Weight Management: As obesity and rapid weight loss are significant risk factors in the development of gallstones, maintaining a healthy weight can help prevent their formation.

  • Balanced Diet: Maintain a diet high in fibre and healthy fats, while limiting intake of refined carbohydrates and unhealthy fats.

  • Regular Physical Activity: Aim for at least 150 minutes of moderate-intensity aerobic activity, such as brisk walking, each week. Alternatively, engage in 75 minutes of vigorous-intensity activity, such as running.

  • Control of Blood Sugar Levels: For people with diabetes or insulin resistance, controlling blood sugar levels through diet, exercise, and medication can help reduce the risk of gallstones.

Frequently Asked Questions About Gallstones in Singapore

Can gallstones go away on their own?

Gallstones generally do not disappear on their own. While small gallstones may occasionally pass through the stool, larger stones are likely to remain. In such cases, a gallbladder removal surgery in Singapore may be needed to address the problem.

The recovery time for gallbladder removal (cholecystectomy) varies. For laparoscopic cholecystectomy, patients often recover within two weeks. Meanwhile, an open cholecystectomy typically requires a longer recovery period of six to eight weeks.

Initially, a bland diet with minimal fats and fibre may be recommended as the digestive system adjusts after gallbladder surgery. Consult your doctor on how to gradually return to a normal, healthy diet.

After gallbladder removal, gallstones generally cannot recur. However, if gallstones were present in the bile ducts or form there subsequently, further intervention by a gallbladder surgeon may be necessary.

Related Gallbladder Treatments

Corporate & Personal Insurance Plans

Our Clinic Location

Precision Surgical Centre
@ Gleneagles Hospital Annexe Block

Precision Surgical Centre @ Gleneagles Hospital Annexe Block

Clinic Locations

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Nexus Surgical @ Mt. Alvernia

Nexus Surgical @ Mt. Elizabeth Orchard

Nexus Surgical @ Mt. Elizabeth Novena

Nexus Surgical @ Parkway East

Nexus Surgical @ Gleneagles Medical Centre

Need help navigating your health?

If you’re experiencing symptoms or want to understand your treatment options, contact us today.