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Forum Name: Surgery Topics

Question: Gall Bladder Surgery


 Ballerina Girl - Fri Aug 20, 2010 10:09 am

I have gall stones, with the largest measuring 1.4cm. I do not have many symptoms. Every once in awhile I feel a bit of discomfort, but have never had an attack.
I will be moving very soon to a country where the medical practice is not adequate in the case that an attack or something worse may occur. I would have to be medi-vac-ed out to a more modern country if something happened.
Is it worth it to have the surgery now?
 Dr.M.Aroon kamath - Thu Aug 26, 2010 1:53 am

User avatar Hi,
Cholecystectomy is generally advised for individuals with gall bladder stones because of the risk of certain complications, which at times may even be life threatening. two major concerns.
- the risk of complications (biliary colic, acute cholecystits,empyema of the gall bladder, acute pancreatitis etc) and
- a risk for carcinoma of the gall bladder.

Generally, only about 10-20% of known silent stones will become symptomatic.In individuals who do become symptomatic, 15-20% will develop acute cholecystitis (independent of age). 8% will develop obstructive jaundice – this tends to rise with age.

In one follow – up study of individuals with asymptomatic gallstones at the University of Michigan, it was found that over a 20 year period, only 18% developed biliary pain and that the mean yearly probability of the development of as non–lifethreatening biliary colic wa 2% during the first 5 years; 1% during the second 5 years; 0.5% during the third 5 years; 0% during the fourth 5 years. A very important observation noted in that study, was that no person ever presented a biliary complication as an initial manifestation of his biliary disease. None of these individuals died because of gall stone disease.
Gracie WA, Ransohoff : The natural history is not a myth. New Eng J of Med.1982;309:78-800.
Mcsherry CK, Ferstenberg , Calhoun WF , et al. The natural history of diagnosed gall stone disease in symptomatic and aysmtomatic patients. Ann Surg 1985;202;59-63.

The progression from asymptomatic to symptomatic state usually follows a step-wise pattern. Non-specific symptoms-to biliary colic- and later, complications such as acute cholecystitis. It is rare for acute cholecystitis to develop without antecedent biliary colic.

In contrast,the presence of common bile duct stones, even when
incidental, warrants active intervention to remove the stones.
More than 50% of patients with retained bile duct stones are likely to develop symptoms and 25% will develop serious complications.

Although gall stones are known to be associated with cancer of the gall bladder
(> 70% of patients developing gallbladder carcinoma have gallstones), the risk in patients with aysmptomatic gall stones is < 0.01%—less than the mortality associated with Cholecystectomy. Calculations show that at least 100 cholecystectomies need to be done to prevent one death from gallbladder carcinoma. The conclusions drawn from several studies indicates that prophylactic cholecystectomy for asymptomatic gallstones can not be recommended for this reason.

However, the American Indian women and the Chilean Hispanic and Indian population with gallstones represent the only exceptions to this recommendation. Because of the early onset of gallstones in that population, there is an increased risk of gallbladder cancer and therefore, prophylactic cholecystectomy appears to be justified.

Prophylactic cholecystectomy appears to be justified in certain situations such as,
- Patients with porcelain gall bladder (a rare occurrence of a calcified gall bladder wall, which has an associated risk of gall bladder carcinoma in 13–22% of patients),
- certain populations(as already alluded to),
- individuals residing far from urgent medical help,
- patients with sickle cell disease(early onset of gall stone disease, difficulties in distinguishing vaso-occlusive crisis and biliary symptoms),
- other hemolytic anemias,
- immune suppression( e.g. post- organ transplantation).

You indicate that you will be moving to a country where you may be far from expert medical help. Depending on the length of planned stay there, depending on the presence or absence of aforementioned factors, and in consultation with your surgeon, you must take the final decision.
Best wishes!

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