There are some questions I frequently encounter from my patients and my readers who follow the site on the internet about the treatment of gallbladder stones. I thought of collecting my answers to these questions under the title of a single article. I will also give information about my own algorithm that I apply to my patients, and I hope that many patients will benefit from it by answering their questions and eliminating their concerns.
I can summarize the questions I frequently encounter as follows:
I have stones in my gallbladder. Is surgery necessary or necessary?
What happens if I do not have surgery for gallbladder stones? Is there any danger?
When should I have surgery for gallbladder stones?
Will I have any problems after the surgery?
Before answering these questions, I will briefly summarize a word that should be remembered:
Not every gallbladder stone requires surgery.
Before answering the questions above, I think it would be useful to mention some important points about gallbladder stones. One of the most important criteria when diagnosing gallstones is the presence or absence of complaints. If the patient has no complaints, the decision for surgery should be reviewed again and again.
Gallstones may sometimes not cause any complaints for years. This condition is called "silent stone" or "asymptomatic gallstone" and does not require treatment. There is no direct connection between the size and number of gallstones and the symptoms. While a very small stone may cause excessive complaints, very large stones or even stones that completely cover the gallbladder may be symptomless.
Intense pain in the upper right side of the abdomen is a characteristic of gallstones. It is a symptom and in medical terms it is called "gallstone attack or attack". This pain often increases over several hours and is accompanied by nausea and vomiting. The patient may also feel pain between the shoulder blades or under the right shoulder. Sometimes these symptoms resemble a "kidney stone pain". Usually, attacks occur after a particularly fatty meal and almost always happen at night and after drinking. A positive Murphy sign is a common finding on physical examination.
In developed countries, 10-15% of adults have gallstones, but only 80 of them have no complaints.
Abdominal ultrasound sensitivity and specificity in the diagnosis of gallbladder stones is 95%.
Now let's come to the answers to the questions above
I have stones in my gallbladder, is surgery necessary or necessary?
Answer: Generally, if you have no complaints, there is no need for surgery. It would be useful to list some criteria for surgery
Complaints: If you have no complaints, abdominal ultrasound and liver enzymes (LFT) checks 1-2 times a year are sufficient. If you experience a complaint only once and it is not very severe, you do not need to have surgery immediately. Medical treatment and a gallbladder-protective diet can prevent these complaints from recurring. In case of a second attack, surgery is necessary!
Gallbladder factor: If there is wall thickening in the gallbladder, signs of cholecystitis, or if the gallbladder is attached to other abdominal organs, it is beneficial to have surgery.
Gallstone factor. : If stones <3 mm and no more than 2 stones cause any complaints, there is no need for surgery. These stones have the chance to disappear spontaneously over time, with medical treatment and diet. It is beneficial to undergo surgery for stones of 3-7 mm size, as there is a risk of falling into the bile ducts and causing obstruction. There is no need for surgery as stones >7 mm have no chance of falling into the canal.
Patient factor: Especially in diabetic patients, since there is damage to the nerve tissues feeding the gallbladder, the complaints may not be too severe and can be deceptive. In this group of patients, perforation and bile leakage may occur in the gallbladder wall over time. Therefore, surgery is recommended in these patients. Surgery is not recommended for elderly (>70y) or very young (<16y) patients. In patients with other health problems (for example, advanced heart failure, stroke patients, terminal cancer and metastasis patients, etc.), a judgment should be made between the benefits and harms of surgery and the decision should be made according to the dominant condition.
Other factors. : Surgery is recommended for patients who frequently have biliary tract inflammation (cholangitis attacks) and pancreatic inflammation (acute pancreatitis attacks).
What happens if I do not have surgery for gallstones? Is there any danger?
Answer: Especially 3-7 mm sized stones can pass through the bile ducts. Since there is a risk of falling into the vagina and causing an obstruction, it is beneficial to undergo surgery, otherwise it may cause serious problems (for example, obstructive jaundice, pancreatitis). Surgery is recommended for patients who experience more than two complaints within a year, in order to prevent the gallbladder from sticking to the surrounding tissues and complicating the surgery.
When should I have surgery for gallstones?
Answer: Sometimes acute cholecystitis and gallbladder perforation due to gallstones that do not respond to medical treatment may require emergency surgery. Apart from this, gallbladder surgery is an elective procedure and can be planned at a convenient time. There is no need to always rush!
Will I have any problems after the surgery?
Answer: Perhaps this is one of the most important questions! When the correct decision is made according to the criteria determined as explained above, 85-90% of the patients do not experience serious problems after the surgery and most post-operative complaints (e.g. belching, nausea, bloating, abdominal pain, etc.) are temporary and disappear within an average of 2-3 months. disappears completely. These patients breathe a sigh of relief for the rest of their lives and are always grateful that they had surgery.
However, unfortunately, 10-15% of the patients face different complaints after the surgery, even though everything goes well. These complaints can sometimes be a simple nausea that lasts a lifetime, or unbearable abdominal pain and cramps. Patients in this group are called "Post Cholecystectomy Syndrome". Unfortunately, the complaints in these patients arise from the lack of bile storage and it is impossible to predict or see this situation before surgery. However, there is an important point that should never be forgotten. We see that closed bladder (Laparoscopic cholecystectomy) surgeries, which have become the gold standard in gallbladder surgeries especially in recent years, sometimes lead to serious complications. Patients in this group are also called "Post Cholecystectomy Complications". Patients in both groups have almost the same complaints, but the pathologies are very different. For example, unknowingly puncturing the liver, small intestine or other organs during surgery, removing only a part of the gallbladder, removing gallstones from the abdomen during surgery. falling into the cyst, leaving the cystic duct too long or cutting the common bile duct, incorrectly placing the clips during surgery, etc. I will discuss the complaints that develop after gallbladder surgery in detail in my next article. You can follow the new article here.
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