Do I need to have gallbladder surgery?

Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

The gallbladder is a small sack in the right upper abdomen below the liver and above the head of the pancreas. It holds bile, a fluid secreted from the liver. It is common for water to be extracted from the bile in the gallbladder. This can lead to formation of sludge and hardened gallstones, a condition called cholelithiasis. Gallstones are most often asymptomatic, but they can cause abdominal pain and in severe cases, infection. They rarely death.

Gallstone disease is one of the most common of all digestive diseases. The U.S. Centers for Disease Control and Prevention estimates that 6.3 million men and 14.2 million women in the United States have gallbladder disease. There is marked variation in the prevalence between ethnic groups.

There are higher rates in western European, Hispanic and Native American populations and lower rates in eastern European, African American and Asian populations. This is mostly because of differences in diet.

Family history and genetics are important risk factors. Women are more likely to develop gallstones; having had a large number of children also increases risk. Those with obesity, high triglycerides and diabetes are at increased risk for gallstones. Rapid weight loss through crash dieting and weight reduction surgery is a risk factor for gallstones. Some doctors recommend these people take the drug ursodeoxycholic acid to prevent gallstone formation.

Studies suggest that a high intake of coffee, vegetable protein or polyunsaturated and monounsaturated fats are associated with a lower risk of gallstone disease.

Asymptomatic gallstones are extremely common, rarely progress to symptoms and should be left alone. These are often discovered through an abdominal ultrasound or a CT scan done for other reasons.

Patients with symptoms of gallbladder disease need to be treated. The most common symptom is "biliary colic" or a "gallbladder attack," which is pressure or pain usually caused by stones pressing on the gallbladder sphincter as the gallbladder contracts in response to a fatty meal. The pain is usually constant despite the name colic. It commonly radiates to the back and right shoulder. It can be associated with sweating, nausea and vomiting. It can be severe and then plateau over an hour or so as the gallbladder relaxes.

Symptoms of a gallbladder attack are nonspecific and should be evaluated by a skilled clinician. They can be confused with symptoms of peptic ulcer disease, cardiac chest pain, esophageal chest pain, gastroesophageal reflux disease, irritable bowel syndrome, hepatitis and pancreatitis. Gallstones can be a cause of pancreatitis.

Patients with gallstones and pressure or pain often need surgery to remove the gallbladder.

This operation is called a cholecystectomy. In one study, 70 percent of people with these symptoms received surgery within two years.

For those with mild symptoms, drug therapy with ursodeoxycholic acid is sometimes attempted to dissolve stones. Lithotripsy, which is an ultrasound therapy to break up stones, is also used. Both of these treatments are frequently not successful.

Both have decreased in popularity as minimally invasive laproscopic cholecystecomy has become commonly available. This is a surgery in which a small incision is made usually in the umbilicus (belly button), and the gallbladder is removed through a scope.

The presence of fever and constant abdominal pain can signal that the condition has progressed to acute cholecystitis. This is an infection that needs to be treated immediately and is often a surgical emergency.