Gallstones were found by chance and nothing hurts. Do I need surgery?

Usually not. Asymptomatic stones are operated on only in specific situations — for example, with calcification of the gallbladder wall. If a typical attack of pain occurs, surgery is worth discussing.

Can you live without a gallbladder?

Yes. Bile keeps flowing from the liver into the bowel; it just is not stored. No special diet is needed after surgery.

I have a 7 mm polyp. What should I do?

If there are no risk factors — age over 60, a broad-based polyp, focal wall thickening, sclerosing cholangitis — it is checked by ultrasound at 6 months, 1 year and 2 years. With risk factors, removal of the gallbladder is recommended.

Can gallstones be dissolved with pills?

It is not routinely recommended: only small cholesterol stones in a well-contracting gallbladder can be dissolved, and only in some patients. Stones often re-form after the drug is stopped, so surgery is the standard for symptomatic stones.

When is the best time to operate for acute cholecystitis?

As early as possible, ideally within 72 hours: early laparoscopic surgery is safe and shortens the overall treatment time. If the patient’s condition does not allow surgery, the inflammation is treated and the gallbladder is removed later.

Gallstones and gallbladder polyps: laparoscopic cholecystectomy

Many people have gallstones, and in most of them the stones never cause any trouble. Surgery is needed when the stones cause attacks of pain or complications — gallbladder inflammation, jaundice, pancreatitis. The standard treatment is laparoscopic removal of the gallbladder through a few small incisions. Gallbladder polyps are a separate issue: most are benign, but polyps of 1 cm or more and those that grow are best removed together with the gallbladder so as not to miss cancer.

Kateryna Valikhnovska, MD, surgical oncologist, during a laparoscopic operation — The laparoscopic stage of an operation: the lights in the operating room are dimmed because the surgeon works from the camera image on the monitor.

Why gallstones and polyps form

Stones form when bile is oversaturated with cholesterol or the gallbladder empties poorly. Female sex, age, obesity, rapid weight loss, pregnancies, diabetes and family history increase the risk.

Gallbladder polyps are most often cholesterol deposits on the wall — they do not become malignant. True neoplastic polyps are less common; the risk of cancer rises with polyp size, age over 60, a broad-based polyp and primary sclerosing cholangitis.

Are there symptoms

In most people, gallstones cause no symptoms. The typical sign is biliary colic: severe pain under the right ribs or below the breastbone lasting from half an hour to several hours, often after a fatty meal or at night. Prolonged pain with fever suggests acute cholecystitis, yellowing of the skin and eyes suggests a stone in the bile duct, and band-like pain suggests pancreatitis. Bloating and heaviness after meals alone are more often unrelated to gallstones.

Polyps usually cause no symptoms and are found on ultrasound.

Examinations needed

Abdominal ultrasound — the main test: stones, polyps, gallbladder wall thickness, bile duct width.
Chemistry panel — bilirubin, liver enzymes, amylase or lipase.
MRCP — if bile duct stones are suspected; endoscopic ultrasound is an alternative.
For polyps — ultrasound by an experienced specialist: size, shape of the base, relationship to the wall; if in doubt — contrast-enhanced or endoscopic ultrasound.

When surgery is needed

Cholecystectomy is recommended for symptomatic gallstones — after the very first attack of colic, the risk of further attacks is high and the risk of complications substantial. In acute cholecystitis, the gallbladder is best removed as early as possible — ideally within 72 hours; after mild gallstone pancreatitis — during the same admission; after severe pancreatitis — once the inflammation has settled. Asymptomatic stones are usually not operated on, except in specific situations such as a “porcelain” gallbladder.

For polyps of 10 mm or more, removal of the gallbladder is recommended. Polyps of 6–9 mm are removed if risk factors are present, and otherwise monitored by ultrasound; polyps up to 5 mm without risk factors usually need no follow-up. If a polyp has grown by 2 mm or more, surgery is discussed, taking its size and risk factors into account.

If surgery is not possible now

If surgery is temporarily impossible because of the patient’s condition, acute cholecystitis is treated with antibiotics and, if necessary, ultrasound-guided drainage of the gallbladder, which is then removed later. Bile duct stones are removed endoscopically (ERCP) or surgically — before, during or after cholecystectomy. Stone-dissolving drugs help only a small share of patients and do not prevent recurrence.

How the operation is performed

Laparoscopic cholecystectomy is done through 3–4 small incisions: the gallbladder is separated from the liver, the cystic duct and artery are divided after they have been reliably identified, and the gallbladder is removed in a retrieval bag. The key to this operation is recognizing the anatomy safely so as not to injure the common bile duct.

If cancer is suspected in a polyp, the approach is different: staging comes first, and the gallbladder is removed without opening it, and if cancer is confirmed a more extensive operation is needed — see the gallbladder cancer page.

Gallstones without symptoms are not a reason for surgery. A polyp of 1 cm or more is a reason not to wait.

Kateryna Valikhnovska, MD, surgical oncologist

Recovery after surgery

Care follows the enhanced recovery after surgery (ERAS) protocol. After elective laparoscopic cholecystectomy, patients are often discharged the next day and return to normal activity within 1–2 weeks. No special diet is needed afterward; some people have looser stools after fatty meals for the first few weeks.

The removed gallbladder is always sent for pathology.

Follow-up

After cholecystectomy no follow-up is needed if pathology shows no changes. Polyps of 6–9 mm without risk factors are checked by ultrasound at 6 months, 1 year and 2 years; if the polyp does not grow, monitoring stops.

What to bring to the consultation

ultrasound reports, ideally several — to assess any change in a polyp;
chemistry panel;
MRCP or other tests, if performed;
discharge summaries, if you were hospitalized with cholecystitis, jaundice or pancreatitis;
a list of other conditions and medications, including anticoagulants.

If some materials are missing, that is no reason to postpone the consultation: some examinations can be done on site.

The consultation is free of charge. How it goes and how long it takes is described on the page “Oncologist Consultation”.