Gallstones and Gallbladder Disease - Surgery

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The type of surgery performed on specific patients may vary depending on different factors.

Appropriate Surgical Candidates. Candidates for gallbladder removal often have, or have had, one of the following conditions:

• A very severe gallstone attack
• Several less severe gallstone attacks
• Endoscopic sphincterotomy for common bile duct stones (in patients with residual gallbladder stones)
• Cholecystitis (gallbladder inflammation)
• Pancreatitis (inflammation of the pancreas) secondary to gallstones
• High risk for gallbladder cancer (such as patients with anomalous junction of the pancreatic and biliary ducts or patients with certain forms of porcelain gallbladder)
• Chronic acalculous gallbladder disease (also called biliary dyskinesia), in which the gallbladder does not empty well and causes biliary colic, even though there are no gallstones present

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The best candidates are those with evidence of impaired gallbladder emptying.

Pregnant women who have gallstones and experience symptoms are also candidates for surgery.

Timing of Surgery. Cholecystectomy may be performed within days to weeks after hospitalization for an acute gallbladder attack, depending on the severity of the condition.

• Emergency gallbladder removal within 24 - 48 hours is warranted in about 20% of patients with acute cholecystitis. Indications for surgery include deterioration of the patient's condition, or signs of perforation or widespread infection.
• Under debate is what type of surgery and timing are most appropriate for patients with acute cholecystitis whose condition improves and who have no signs of severe complications. Previously, the standard was open cholecystectomy between 6 - 12 weeks after the acute episode. Some evidence now suggests that patients who have early surgery (performed between 72 - 96 hours after symptoms begin) have fewer complications than those who wait to have surgery.

General Outlook. Although cholecystectomy is very safe, as with any operation there are risks of complications, depending on whether the procedure is done on an elective or emergency basis.