How to choose the treatment plan for gallstones? Medication or surgery

Gallstones are a common clinical disease, especially in middle-aged and obese women. Many patients have no obvious symptoms, or only mild atypical symptoms, such as upper abdominal pain, bloating, fullness after meals, indigestion, etc. There are also many patients who “accidentally” discover gallstones during physical examinations and B-ultrasound examinations.

Then, a series of questions arise: How to choose the treatment plan for gallstones? Do I need to take medicine or surgery? Can medicine cure it? When should I have surgery and what kind of surgery should I have? Is the surgery traumatic? Will there be sequelae? In addition to surgery, are there other ways to remove stones?

Below, we sort out these questions and answer them one by one:

Question 1

What is the natural course of gallstones and are the consequences serious?

1. Asymptomatic gallstones: Most patients with gallstones have no obvious symptoms for a long time. According to the long-term follow-up observation of some patients with asymptomatic gallstones, this group is a benign disease group with a mild course of disease. Few patients will have severe symptoms and require surgery within 10 to 15 years.

2. Symptomatic gallstones: The “symptoms” here refer to severe gallstone-related symptoms such as biliary colic and acute cholecystitis, and do not include general indigestion symptoms. Symptomatic gallstones not only have a significant impact on the patient’s life, but studies have also shown that this group has a higher risk of acute cholecystitis, pancreatitis, and biliary obstruction.

3. Possibility of developing gallbladder cancer: Gallbladder cancer is the most serious complication of gallstones. But generally speaking, the possibility of occurrence is very small. Large gallstones, American Indians, porcelain gallbladder and abnormal pancreaticobiliary duct junction are considered to be high-risk factors for gallbladder cancer.

Question 2

After confirming gallbladder stones, what are the basis for choosing a treatment plan?

In the past, there was a tendency to “treat everything” for gallstones, especially with the popularization of laparoscopic technology, which has made this tendency more serious. However, given that the gallbladder has many functions such as storing concentrated bile, regulating bile duct pressure, and building the bile duct immune system, whether surgery is needed should be carefully considered in combination with the patient’s specific condition.

Factors that need to be considered when deciding on a treatment plan include: how severe the patient’s symptoms are (are the benefits of surgery great?), whether the gallbladder is functioning normally (how big will the side effects of surgery be?), and whether the gallbladder has inflammation, complications, or malignant changes (other factors that increase the necessity of surgery).

Question 3

What treatment options are currently available? What are the pros and cons of each?