Treatment Guideline for Asymptomatic Gallbladder Stones (Gallstones).

Treatment Guideline for Asymptomatic Gallbladder Stones (Gallstones). Doctors have known for a long time that gallstones can cause problems.

Eventually Gallbladder Stones trigger the Problem:

Studies show that between 12% and 24% of people with gallstones that don’t cause any symptoms (asymptomatic) will eventually develop pain or other issues (symptomatic) within 9 to 20 years. There’s also a 3% to 8% chance of complications like infection for people with asymptomatic gallstones over that time.

The risk is higher for people who already have symptoms from gallstones. Studies show that 19% to 37% of these folks will have their symptoms come back within 1 to 14 years. They also have a 4% to 30% chance of complications during that time.

Overall, between 22% and 51% of people with symptomatic gallstones will eventually need surgery (cholecystectomy) to remove their gallbladder due to either returning symptoms or complications. This is much higher than the 8% to 26% of people with asymptomatic gallstones who eventually have surgery.

Should You Remove Gallstones That Don’t Cause Problems?

Doctors usually don’t recommend surgery to remove gallstones if they aren’t causing you any pain or discomfort (asymptomatic) based on previous studies.

Here’s why:

• Low Risk: Most people with silent gallstones never develop problems from them. The chance of symptoms or complications arising each year is only around 1% to 4%.
• Surgery Risks and Costs: Surgery (cholecystectomy) to remove the gallbladder has its own risks, like infection or anesthesia problems or bile duct injury. It can also be expensive.

Who Might Need Surgery Anyway?

Some factors may increase your chance of problems from silent gallstones:

• Younger Age: People under 55 or expected to live over 20 years might be at higher risk.
• Female: Women are more likely to experience issues.
• Smoking: Smokers have a higher risk.
• Weight: People with a higher body mass index (BMI) may be at greater risk.
• Gallstone Details: More numerous stones, floating stones, larger stones (over 2 cm), very small stones with a clear cystic duct, or a non-functioning gallbladder could indicate a higher risk.

Gallstones and Other Health Issues: When Preventive Surgery Might Be Right

Gallstones can sometimes be silent – they’re there, but they don’t cause any pain or problems. In most cases, doctors recommend leaving them alone.

However, there are certain situations where removing the gallbladder (cholecystectomy) as a preventive measure might be beneficial.

Here’s a breakdown of some conditions where this approach might be considered:

1. Blood Disorders:

• People with certain red blood cell issues, like sickle cell anemia or hereditary spherocytosis, are more prone to gallstones. Studies show these individuals have a higher risk of problems from silent gallstones. Preventive surgery can potentially reduce complications and shorten hospital stays compared to waiting for symptoms to arise.

2. Organ Transplants:

• People who have received organ transplants seem to have a higher chance of developing problems from silent gallstones compared to the general population. Studies suggest that removing the gallbladder before transplant surgery might lead to better outcomes for the transplanted organ and reduce complications and healthcare costs.

3. Neuroendocrine Tumors:

• These tumors can sometimes be treated with medications like octreotide. Unfortunately, this medication can also increase the risk of gallstones and related issues. In such cases, preventive gallbladder removal might be recommended.

Other Considerations:

• While less clear-cut, some doctors might consider preventive surgery for very large gallstones (over 3 cm), polyps in the gallbladder found during other tests, or if gallbladder removal is planned during weight loss surgery (bariatric surgery) anyway.Additionally, some people with diabetes might be considered for preventive surgery, but this is still debated among healthcare professionals.

Waiting May Invite more Risk & Complications:  

Should You Wait for Gallstones to Cause Problems Before Surgery?

Imagine you have gallstones, but they aren’t causing any pain or discomfort (asymptomatic). Doctors typically recommend leaving them alone for now.

However, there are some downsides to waiting for symptoms to develop before removing the gallbladder (cholecystectomy).

Here’s why:

• Lower Surgical Risks:

  Removing the gallbladder when there are no symptoms (elective surgery) carries a lower risk of complications compared to waiting for an emergency due to pain or infection.

• Reduced Cancer Risk:

  Studies suggest early cholecystectomy might lower the risk of gallbladder and bile duct cancers, especially if you have polyps, large gallstones, or a hardened gallbladder (porcelain gallbladder).

• Improved Survival Rates:

  Research shows people with gallstones who undergo cholecystectomy have a lower overall death rate compared to those who don’t.

Waiting Can Mean More Complications:

• Emergency Surgery Risks:

  If you wait and experience complications like inflammation (cholecystitis), you might need emergency surgery, which carries a higher risk of problems compared to elective surgery.

• Open Surgery vs. Laparoscopic:

  Laparoscopic surgery (minimally invasive) is preferred for cholecystectomy. However, with complications, open surgery (larger incision) might be necessary, leading to a longer recovery and potential complications like hernias.

• Trickier Surgery:

  When inflammation is present, removing the gallbladder becomes more challenging for the surgeon, increasing the risk of complications during surgery.

• Incomplete Removal:

  In some cases, due to inflammation, complete removal of the gallbladder might not be possible (subtotal cholecystectomy). This can lead to problems like retained stones and bile leaks, requiring further procedures.

Who Might Benefit from Early Gallstone Removal?

• People with multiple small stones (< 1 cm)
• People with a single large stone (> 1 cm)
• People with significant sludge in the gallbladder
• Young, healthy individuals to avoid future complications
• Older adults in good health to avoid surgery risks later in life, when they might be frailer

Gallstones: To Watch or Remove? A Patient’s Guide

Treatment Guideline for Asymptomatic Gallbladder Stones (Gallstones). This article discussed the pros and cons of removing the gallbladder (cholecystectomy) for people with gallstones that don’t cause any problems (asymptomatic). Here’s the bottom line:

• Doctors typically recommend waiting because most people with silent gallstones never have issues. Surgery also has risks and costs.
• We believe all patients with silent gallstones should discuss options with their doctor. This empowers you to make an informed decision based on your individual situation.
• Some factors might increase your risk of problems from silent gallstones. These can be discussed with your doctor to see if preventive surgery might be right for you.
• Ultimately, the choice is yours. While doctors may have recommendations based on research, you have the right to decide what’s best for you.

The key takeaway: Don’t just wait and see if problems arise. Talk to your doctor about your specific situation and explore all options to make the best decision for your health.