Gallstones
The diagnosis of gallstones is normally made using abdominal ultrasound or on CT. We know that about 1 in 5 people in the community have gallstones but we do not operate on every individual. What we do with the diagnosis depends on why the scan was done. It is very different if the scan was done because you have abdominal pain or other symptoms compared to if you have no symptoms.
Gallstone problems can be classified into three groups: incidental, uncomplicated and complicated. Gallbladder polyps is a different pathology and are discussed below.
Incidental
The gallbladder can normally be left alone as it likely surgery will not benefit and even cause harm. There are unusual cases where we would consider this such as after specific types of bariatric or cancer surgery.
Uncomplicated
Gallstones can cause pain and inflammation in the gallbladder. Sometimes this is a “one-off" event and for some people they have chronic symptoms. These cases are normally treated with removing the gallbladder (a cholecystectomy) but there is some leeway as to whether an operation “must” be done.
Complicated
This is when gallstones trigger further downstream problems in the bile duct or the pancreas.
These are complicated because now multiple organs have become affected by the gallstones. These are unusual presentations but can become life-threatening. This is a routine X-ray taken during such an operation for a woman with jaundice from gallstones. Dye is injected down the bile ducts and this X-ray shows a stone lodged at the bottom of the bile duct. A keyhole exploration was performed to remove the stone and she went home the next day.
My recommendation for surgery is usually much stronger and we may need to explore the bile ducts.
Gallbladder Polyps
On occasion a scan will reveal polyps within your gallbladder. These are invariably an incidental finding but in very rare cases have a risk of progressing to gallbladder cancer once the polyp is beyond a certain size. We leave the vast majority of polyps less than 5mm alone. Polyps between 5-10mm normally require repeat scans.
Unfortunately if the polyps are growing in size rapidly or are greater than 10mm then the removal of the gallbladder is normally recommended. If there are complicating factors such as gallstones and polyps this requires further discussion.