Laparoscopic Gallbladder Surgeries

The gallbladder is a bag-shaped organ located in the lower part of the liver, containing the gall which is secreted from the liver. It is a small, pouch-shaped organ with an average length of 10 cm and a width of 3 cm. It is located on the lower face of the liver in contact with the liver. It stores, concentrates the gall juice, and transfers it to the bowel by straining when foods pass through stomach to the small bowel. So it helps to digest the foods we eat.

Various diseases such as stones, polyps, dysfunctions and gallbladder cancers can be seen in the gallbladder.

What is a polyp? How frequent it is seen in the gallbladder?

That the cells present in the mucosal layer laying the inside of the digestive system grow at their location and form a little node is called polyp. Polyps can be seen at different rates in the entire digestive system. The gallbladder polyp is detected in 1.5-4.5% of all patients who underwent ultrasonography (USG) in the polyclinics. The disease is more common in 40s and in women. It is rarely seen in childhood but requires additional examination when it is detected.

What are the indications?

Nausea, vomiting, abdominal pain (abdominal pain starting from the upper abdomen and felt under the right shoulder blade bone), jaundice may occur. However, there is usually no indication in people with gallbladder polyps and polyps are coincidentally detected by an abdominal ultrasound made for another reason.

Why and to which extent the gallbladder polyps are important?

Real polyps (adenomatous polyps) are rarely seen in the gallbladder. Most polyps in the gallbladder were cholesterol polyps (60%), adenomyomas (25%) and inflammatory polyps (10%) that do not a pose a cancer risk. Adenomas, which are true polyps in the gallbladder, constitute only 4-5% of all gallbladder polyps. But this group is the most important because they carry the risk of cancer. 25% of adenomas are cancerous and all adenomas larger than 12 mm contain cancer cells. In other words, 1% of all gallbladder polyps are at risk of cancer. The size and appearance of the polyp in USG can give an idea to determine the risk of cancer. The risk of cancer for the lesions having a broad base and greater than 10 mm in size is 37%, while the risk of malignancy for pedunculated polyps smaller than 10 mm in size is negligible. If USG findings are suspicious, computed tomography and endoscopic ultrasonography can be used.

Should everyone having a gallbladder polyp operated?

The most important issue to be decided when the polyp is detected is which group of patients should be operated and which ones should be just followed. Because, if we operate all of the polyps, as only 1% of these cases have a risk of cancer, the remaining 99% will be unnecessary surgeries. Therefore, it is necessary to know the risk factors regarding this subject and to determine the surgical decision according to these risk factors. The factors that increase the cancer risk for the polyp are: its size being greater than 1 cm., having a broad base, growing rapidly, and the individual’s age is beyond 50. In line with these information, if the polyp is symptomatic (if accompanied with pain, nausea, vomiting) or has caused additional problems (such as gallbladder inflammation, pancreatitis), it should be operated regardless of the diameter or other factors such as appearance. If non-symptomatic polyp is present and is greater than 1 cm, then it is operated. Despite its size smaller than 1 cm., if the non-symptomatic polyp shows a rapid growth in follow-up, or if it has a solid and broad-based structure, or if there are three or more polyps in millimetric size, or if there are gallstones accompanied therewith, or if the person is over 50 years of age, then the surgery should be recommended.

Laparoscopic (closed) surgery of the gallbladder is the gold standard in these cases. However, in the rare cases having a high risk of cancer and showing in pre-operation inspections the lesions went beyond the bladder wall, open surgeries may be made as occasion requires. (I will talk about laparoscopic surgeries and their advantages in another article.)

As for other cases not covered by this scope (most of polyps are in this category), an USG check every three or six months is sufficient, according to the structure of the polyp.