What should I do when I have silent gallstones?
Gallstones arise from an inablity to keep the solutes in the bile from precipitating. Now this is a simplified statement. And I believe your surgeon would be able to explain the altered mechanics (we call it pathophysiology) that led to gallstones. Gallstones have become quite common in our country, most likely better detection and also possibly the change in the lifestyle and eating patterns of the population.
It is quite common to detect gallstones on ultrasound examination, especially when done for other reasons. Detection of gallstones elicits anxiety among the patients and their family. We call them incidental or silent gallstones. In the early days of ultrasound, this was a major issue and two major studies have looked into the issue. One of the studies was from the University of Michigan and followed Michigan University faculty members who had incidental gallstones for a period of 15 years. at 15 years, onlly 18 % of the total patients developed problems due to the gallstones. If these patients would have been operated, 82 % of the patients would have undrgone an operation which would not have benefited them. The second study was called the GREPCO study from Italy, where at least one episode of pain was noted after 5 years in about 26% of patients out of a total of 115 patients.
Obviously, removing your gallbladder when you have no symptoms (usually abdominal pain) is not needed. But this does not seem to eliminate fear from my patients. "What if I develop a complication?" is one of the most common questions that is asked.
Death from gallstone disease is rare. It can occur, but is rare. It occurs in the elderly or as a result of post operative complications. It simply is rare to die of simple gallstones. Complications may be infection in the gallbladder (Cholecystitis), slipping of the stone into the common bile duct, infection in the biliary tree and acute pancreatitis. Again, I look into the evidence (10 studies done from 1982 to 2004), where the incidence of complications is low (0 - 6 %). From clinical experience in treating complicated gallstone disease, I have seen that pain precedes any complication and over 13 years, I have not seen a patient with complicated gallstone disease, which had not warned earlier with pain. So be assured, unless you develop abdominal pain, you only need follow up and certainly do not need an operation.
Before I conclude, I would also state a few exceptions to the general rule. We do operate on patients with asymptomatic gallstones under specific conditions. I have also listed them so that you can make an informed decision. Patients with sickle cell disease, genetically predisposed patients (Pima Indians, I am sure you may not be one), calcification in the wall of the gallbladder, long term total parenteral nutrition and cardiac transplants. These, of course, are rare. Nevertheless, we surgeons also look into those special situations.
Of course, please see your surgeon and discuss these issues. Confirm that you truly have asymptomatic disease, before you decide against surgery.
It is quite common to detect gallstones on ultrasound examination, especially when done for other reasons. Detection of gallstones elicits anxiety among the patients and their family. We call them incidental or silent gallstones. In the early days of ultrasound, this was a major issue and two major studies have looked into the issue. One of the studies was from the University of Michigan and followed Michigan University faculty members who had incidental gallstones for a period of 15 years. at 15 years, onlly 18 % of the total patients developed problems due to the gallstones. If these patients would have been operated, 82 % of the patients would have undrgone an operation which would not have benefited them. The second study was called the GREPCO study from Italy, where at least one episode of pain was noted after 5 years in about 26% of patients out of a total of 115 patients.
Obviously, removing your gallbladder when you have no symptoms (usually abdominal pain) is not needed. But this does not seem to eliminate fear from my patients. "What if I develop a complication?" is one of the most common questions that is asked.
Death from gallstone disease is rare. It can occur, but is rare. It occurs in the elderly or as a result of post operative complications. It simply is rare to die of simple gallstones. Complications may be infection in the gallbladder (Cholecystitis), slipping of the stone into the common bile duct, infection in the biliary tree and acute pancreatitis. Again, I look into the evidence (10 studies done from 1982 to 2004), where the incidence of complications is low (0 - 6 %). From clinical experience in treating complicated gallstone disease, I have seen that pain precedes any complication and over 13 years, I have not seen a patient with complicated gallstone disease, which had not warned earlier with pain. So be assured, unless you develop abdominal pain, you only need follow up and certainly do not need an operation.
Before I conclude, I would also state a few exceptions to the general rule. We do operate on patients with asymptomatic gallstones under specific conditions. I have also listed them so that you can make an informed decision. Patients with sickle cell disease, genetically predisposed patients (Pima Indians, I am sure you may not be one), calcification in the wall of the gallbladder, long term total parenteral nutrition and cardiac transplants. These, of course, are rare. Nevertheless, we surgeons also look into those special situations.
Of course, please see your surgeon and discuss these issues. Confirm that you truly have asymptomatic disease, before you decide against surgery.
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