I once met a patient who had gallbladder stones for more than 10 years, but had been painless and not taken seriously, and was unfortunately diagnosed with advanced gallbladder cancer. The prognosis of gallbladder cancer is very poor and surgeons are often at their wits’ end at this time. What is the probability of gallbladder cancer secondary to gallbladder stones? According to statistics, it is about 1-2%. Although such a probability should not cause panic, we should pay enough attention to it.
In addition, painless gallbladder stones are not painless for a long time. About 30% of patients with asymptomatic gallbladder stones develop symptoms within 10 years, and in serious cases, acute cholecystitis, gallbladder necrosis, acute pancreatitis and other life-threatening complications will occur. Therefore, painless gallbladder stones are like a time bomb in the body, and we should eliminate them at the right time and should not allow them to develop and change.
So, which painless gallbladder stones need surgical treatment? The following is a consensus of indications for surgery for painless gallbladder stones
1. Stones larger than 2 cm.
2, combined with surgery requiring open abdomen.
3, accompanied by gallbladder polyps.
4, thickening of the gallbladder wall.
5, calcification of the gallbladder wall or porcelain gallbladder.
6, gallbladder stones in children.
7, combined with diabetes mellitus or with cardiopulmonary dysfunction.
8, remote or underdeveloped transportation areas, field workers.
9, gallbladder stones found more than 10 years.
The above is the textbook understanding of doctors, although basically correct, but inevitably too general, now the above points for fine interpretation: 1.
1. The larger the stone, the less it will cause abdominal pain, because large stones are less likely to be embedded, but they will cause long-term stimulation to the gallbladder, and eventually the chances of gallbladder cancer are higher.
2. Patients who have a combination of gallbladder stones that require open surgery will undergo cholecystectomy at the same time. However, this is a kind of “hand in hand” feeling, and cannot be generalized, but requires a comprehensive assessment of the need and risk of surgery, that is, weighing the pros and cons.
3. Not all gallbladder stones combined with gallbladder polyps require immediate cholecystectomy, which requires an analysis of the nature and size of gallbladder polyps, and if adenomatous polyps or polyps larger than 1.0 cm are considered, surgical removal is recommended.
4. Thickening of the gallbladder wall is the result of long-term gallbladder stones or chronic cholecystitis, which can lead to loss of contractile function of the gallbladder or even cancer. However, there is no definite conclusion on the extent of gallbladder wall thickening that requires surgery. It is generally believed that gallbladder wall thickening up to 3mm with gastrointestinal symptoms or up to 5mm should be considered for cholecystectomy.
5. What is porcelain gallbladder? This means that the gallbladder wall is calcified like ceramic. There is no need to hesitate to remove the gallbladder as soon as possible because the chance of cancer is too high.
6. The probability of gallbladder stones in children is generally low, but once it occurs, it indicates the presence of congenital malformation of gallbladder contraction or excretion, or congenital cholesterol metabolism disorder, which are irreversible, so the gallbladder should be removed as soon as possible to avoid further development of serious complications.
Combined with diabetes mellitus or cardiopulmonary dysfunction, gallbladder stone surgery should be performed when the condition is stable and there is no abdominal pain attack, because if these patients operate when the gallbladder stone acute abdominal pain attack or complications appear, the risk of surgery is significantly higher, so this “time bomb” should be removed as early as possible when the condition is stable.
8. For workers in the field or remote areas, there is a risk of life-threatening acute attacks of gallbladder stones that cannot be treated in time, so cholecystectomy should be performed at the right time.
9. Patients with long history of gallbladder stones, especially those who have been suffering from gallbladder stones for more than 10 years, should consider timely cholecystectomy because the possibility of gallbladder cancer secondary to long-term chronic irritation of the gallbladder wall is significantly higher despite the absence of pain.
The above points have basically covered the issue of surgical indications for painless gallbladder stones, but based on my long years of clinical experience, I would like to add the following points.
10. Sediment-like stones or multiple small stones, these stones can easily block the bile duct or block the lower end of the common bile duct through the bile duct, leading to severe cholecystitis, cholangitis or acute pancreatitis, so they should also be treated early.
11. Gallbladder atrophy and filled stones, which usually do not cause abdominal pain, but have a high possibility of secondary gallbladder cancer and should be removed as soon as possible.
The above points have comprehensively explained which painless gallbladder stones need timely surgery, but perhaps the patients still have concerns about surgery. In fact, in today’s minimally invasive era, cholecystectomy can be performed in a more “minimally invasive”, “safe” and “aesthetic” manner.