Gallbladder polyp is the morphologic name for a lesion that protrudes or bulges into the lumen of the gallbladder, either spherical or hemispherical, with or without a tip, and is mostly benign.
Pathology can be divided into: 1, tumor polyp, including adenoma and adenocarcinoma, other rare ones are hemangioma, lipoma, smooth muscle tumor, neurofibroma, etc.; 2, non-tumor polyp, such as cholesterol polyp, inflammatory polyp, etc. There are still rare ones such as adenomatous hyperplasia, yellow granuloma, ectopic gastric mucosa or pancreatic tissue. Hou Dongsheng, Minimally Invasive General Surgery Department, The First Hospital of Guangzhou Medical University
Clinical manifestations: Most patients have no special symptoms in plain. A few patients have symptoms similar to cholecystitis, which may include right lower abdominal pressure pain, nausea and vomiting, and loss of appetite; very few patients may cause obstructive jaundice, cholecystitis without stones, biliary bleeding, pancreatitis, etc. Physical examination may include right upper abdominal pain. Ultrasound or cholecystogram is the most commonly used and most economical way to confirm the diagnosis. Because of the small size of gallbladder polyps, they are easily missed on routine CT and MRI. A high clinical suspicion of malignant polyp lesions can be confirmed with Pet-CT.
Treatment: Risk factors for this disease should be noted.
1. diameter of 1 cm or more, especially >1.5 cm 2. single lesion 3. age over 50 years 4. polyps gradually increasing in size, increasing in number, and obvious　
5, combined with gallbladder stones 6, adenomatous polyps 7, wide base 8, thickening of the gallbladder wall (>5mm). If the above factors are present, it indicates that cancer may occur or it may be early gallbladder cancer, so it should be treated by surgery as soon as possible. If there is no such condition, there is no need to rush for surgery, but should review liver and gallbladder ultrasound every 3 to 6 months for regular follow-up. If the following conditions are found in the review, high attention should be paid to them: if the polyps increase in a short period of time, the diameter of polyps increases (more than 2~3mm), and the gallbladder wall thickens (more than 5mm), laparoscopic cholecystectomy can be considered. Laparoscopic cholecystectomy, especially mini-laparoscopic or single-hole laparoscopic surgery, is a mature technique with the advantages of less trauma, faster recovery, fewer postoperative complications and shorter hospital stay for the treatment of benign gallbladder diseases, and is considered the gold standard for the treatment of benign gallbladder diseases. Our hospital is the first hospital in mainland China to carry out laparoscopic surgery and has its own unique technology for the treatment of benign gallbladder diseases. Since the first laparoscopic cholecystectomy was performed in our hospital, we have had more than 16,000 cases of laparoscopic gallbladder surgery in our hospital.
Gallbladder Preservation, Simple Polypectomy —- Gallbladder Preservation SurgeryS With the continuous development and improvement of social technology and minimally invasive techniques, people have increasingly strong demand for gallbladder preservation, and in recent years our hospital has also carried out gallbladder polyp preservation surgery. From our clinical experience in the past few years, we have several personal opinions: 1) the gallbladder has good contraction function and no thickening of the bikini. 2) the number of polyps is not too many, not more than 6, so that the polyps will have less chance of recurrence. 3) larger, fast-growing and highly suspected malignant polyps are not suitable for this surgery, because it will directly affect the surgical efficacy, and if the intraoperative pathology is confirmed as cancer, radical surgery such as regional lymphatic dissection will be done. 4) In patients with wide basal and adenomatous polyps, the basal gallbladder wall should be treated thoroughly, and in some patients, even a small piece of gallbladder wall tissue including polyps should be removed, and then the wound should be sutured and the necessary biological treatment should be done in order to improve patient outcome. Therefore, the laparoscopic surgeon needs to be very skilled, especially in microscopic suturing and dual-scope (laparoscopy, choledochoscopy or nephroscopy) techniques, in order to complete the procedure successfully.5) Younger patients with clear requirements for gallbladder preservation. 6) With the development of biliary surgery for gallbladder polyps, patients with polyps may be considered to undergo surgery earlier, as non-surgical treatments such as medications are not effective. 7) After biliary surgery, the contractile function of the gallbladder will definitely be affected to varying degrees and will only gradually recover later, but it is difficult to return to normal levels. However, it is difficult to return to the normal level. Therefore, in addition to dietary regulation, patients should have regular follow-up abdominal ultrasound after surgery.