Two years ago, I was told I needed gallbladder surgery for gallstones. I had no medical insurance, so I couldn't have the surgery. I keep my fat consumption down to about 10-15g per day. I haven't had a gallbladder attack for a year and a half. I feel fine, but people tell me I'm playing with a ticking time bomb -- that I'm endangering my health and possibly my life by putting this surgery off. Is this true?

Gina

Gallstones are very common among women over age 50, occurring in up to 30 percent of U.S. women in some studies. Gallstones can cause symptoms of pain in the upper abdomen (biliary colic), nausea, vomiting and fever. These attacks occur when a stone moves and obstructs the duct leading out of the gallbladder. If the obstruction lasts for more than several hours, then the gallbladder may need to be removed surgically on a semiurgent basis, because infection could set in.

Other problems that can result if stones make it out of the gallbladder are obstruction of the bile duct and obstruction of the pancreatic duct. These are potentially more serious problems leading to cholangitis (infection of the bile ducts leading out of the liver) or pancreatitis (inflammation of the pancreas). They may require emergency endoscopic procedures to remove stones.

When gallstones are found in the course of tests for other conditions -- rather than because they are causing symptoms themselves -- surgery is generally not recommended, because most people with stones never experience symptoms. So I assume that you found out about your gallstones because of a pain attack that led to an ultrasound. Elective removal of the gallbladder is generally recommended for people who've had an attack of biliary colic, because they face a high chance of recurrence (up to 70 percent). Also, an elective procedure carries far less risk than one that may need to be done semiurgently if the second attack is complicated. The risk of complications in patients who suffer biliary colic attacks is about 1-2 percent per year.

Elective gallbladder surgery is done laparoscopically. If done by an experienced surgeon, the operation has a very low complication rate (about 1 percent) and a short recovery time. Unfortunately, diet and weight management are not effective in preventing further attacks or dissolving stones that are already present.

Although you have not had an attack recently, you should consult with an experienced surgeon regarding your case. This is especially important if you are young and have many years ahead of you during which these attacks could recur.