When a stone grows in the gallbladder, should it be “preserved” or “cut”?
The benefits of “cutting”
First, to prevent the recurrence of stones, polyps and other diseases
For more than 100 years, many doctors have tried to remove the stones without cutting the gallbladder. However, the treatment effect is not satisfactory, and a large number of patients have recurrence of stones after surgery.
The “hotbed doctrine”, founded by Langenbuch in 1882, is highly regarded as the reason for the recurrence of gallbladder stones. He believed that the gallbladder itself is prone to stone production and that simple lithotripsy cannot completely treat gallbladder stones, with a recurrence rate of >90% after surgery. Therefore, he proposed that “the gallbladder should be removed not only because it contains stones, but also because it can grow stones”.
Of course, there is a revolutionary breakthrough in the new era of biliary stone extraction technology, and new technologies such as choledochoscopy have emerged to ensure complete and thorough removal of gallbladder stones and prevent stone residues. However, a clean “cleaning” does not mean a permanent solution, which is equivalent to treating the symptoms but not the root cause, and a significant proportion of people will still recur after surgery.
Second, reduce the stimulation of inflammation and prevent cancer
If the gallbladder is not removed, such repeated attacks will not only burden the patient’s physical and mental health, but also make the condition deteriorate and eventually lead to cancer.
Who needs gallbladder removal
In general, asymptomatic gallbladder stones generally do not require prophylactic surgical treatment. For gallbladder stones with symptoms and/or complications, timely surgery should be performed for.
① high number of stones and stones ≥ 2-3 cm in diameter.
② calcification of the gallbladder wall or porcelain gallbladder.
③ with gallbladder polyps > 1 cm.
④ thickening of the gallbladder wall (>3mm) i.e. with chronic cholecystitis.
⑤ Gallbladder stones in children: those without symptoms are in principle not operated.
Surgery is often considered in the following cases: gallbladder not visualized during oral contrast; female patients older than 50 years of age; gallbladder neck embedded stones; gallbladder atrophy; previous cholecystostomy, etc.
In some elderly patients with gallbladder stones, even though they are asymptomatic and have no other gallbladder co-morbidities, gallbladder stone removal is not recommended. This is because after the age of 60-70, people’s physical condition is not as good as before, and their cardiopulmonary function is also much worse.
What is the significance of “gallbladder preservation”?
First, to avoid indigestion after a high-fat diet
The gallbladder has the function of storage, concentration and contraction, as well as complex chemical and immunological functions. The gallbladder can concentrate the thin bile nearly 30 times and store it in the gallbladder. When fatty foods are eaten, the gallbladder drains the bile into the intestines to participate in digestion. When the gallbladder is removed, the body is prone to indigestion and reflux gastritis.
After the removal of the gallbladder, some patients eat a high-fat diet, the body can no longer release a high quality and sufficient amount of bile on time to help digestion, resulting in bloating, diarrhea (also known as “steatorrhea”) and other symptoms of indigestion.
Second, reduce the incidence of bile duct stones
After gallbladder removal, the stones of gallbladder are gone, however, the incidence of bile duct stones increases, which is a headache. Compared to patients without gallbladder removal, the incidence of common bile duct stones is twice as high in patients with gallbladder removal.
Thus, while gallbladder removal prevents the recurrence of gallbladder stones after surgery, it invites the “disaster” of bile duct stones. More unfortunately, these bile duct stones are often more “aggressive” than gallbladder stones.
Third, the continuous progress of gallstone technology
In the new era, there is a revolutionary breakthrough in gallstone extraction technology, and new technologies such as choledochoscopy have come into being, which can more completely and thoroughly remove gallbladder stones and prevent stones from remaining.
After the stones are removed, the inflammatory stimulus disappears, causing the inflammation of the gallbladder to subside. Although at this stage, “biliary stone extraction” is to some extent “treating the symptoms but not the root cause”, post-operative dietary regimen and avoidance of stone triggers can prevent the recurrence of stones for a longer period of time.
Gallstone extraction is only suitable for some people
Biliary stone extraction is not useless and is preferred in the following cases.
① gallbladder stones without combined septic cholecystitis.
② simple gallbladder stones with mild symptoms.
③ multiple gallbladder stones, but the thickness of the gallbladder wall is <6 mm on B-ultrasound.
④ no history of major right upper abdominal surgery and no abnormal gallbladder position.
⑤ non-atrophic gallbladder stones.
⑥Children and adolescents with gallbladder stones.
After reading these, are you still worried about whether you should “save” your gallbladder or not? It is important to find the most suitable way in the doctor-patient communication, which can treat both “physical” and “mental” diseases. It is important to find the right way in doctor-patient communication to treat both “physical” and “mental” illnesses.