Does the number of gallstones affect a doctor's recommendation on whether a gallbladder should be removed?

Debbie

Gallstones are very common, especially among women starting at about age 20 and increasing with age. Certain populations such as American Indians, Hispanics and Scandinavians are more prone to develop gallstones. Obesity, physical inactivity and recent pregnancy are also risk factors.

Gallstones cause symptoms when they intermittently obstruct the duct leading out of the gallbladder. This leads to abdominal or back pain, nausea and vomiting. The pain (biliary colic) is typically described as severe, sharp pain in the upper abdomen or right side with occasional radiation to the side or back, occurring suddenly and remaining constant for the duration of the episode. If the obstruction lasts for several hours, fever and infection of the gallbladder can occur, and the patient may need to be hospitalized for IV antibiotics and surgery to remove the gallbladder.

More commonly, a patient will see his or her doctor in the office for the intermittent pain described. If the doctor suspects gallstone disease, an ultrasound will be done. This exam can detect the presence of the stones in the gallbladder, as well as any chronic inflammation of the gallbladder wall. If the doctor feels that the stones are the cause of the pain episodes, then he or she typically recommends gallbladder-removal surgery (cholecystectomy).

To answer your specific question, a doctor's recommendation on whether a patient should undergo gallbladder surgery does not depend on the number or size of the stones. Instead, it is based on the simple presence of stones accompanied by attacks of intermittent pain. Once a patient has biliary colic, it will generally recur, and the gallbladder is taken out both to prevent future painful attacks and also to prevent an obstruction or other serious complications.

In the majority of cases, the gallbladder removal is done laparoscopically. This operation involves a few very small incisions and takes about one to two hours. The patient can go home the same night or the next morning in many cases.