When is Treatment Necessary?
In general, only those patients with symptoms should be treated. Patients with no symptoms should be observed unless they fall into special categories:
- Patients less than 40 years of age are candidates for treatment because they have a long life ahead of them.
- Patients with diabetes (sugar) have a higher complication and death rate from gallbladder surgery during acute attacks and therefore should be treated once they are known to have stones.
- Like patients with diabetes, patients with chronic diseases that will get worse but are currently stable and in general good health should be considered for elective treatment. The risk of emergency surgery or elective surgery in these patients is very high if their overall condition has deteriorated.
- Patients with diseases that increase the risk of gallstones, such as blood disorders, should be considered for elective treatment even if they have no symptoms because the risk of common duct stones is frequently higher.
- Finally, patients with a calcified gallbladder should have their gallbladders removed because of a very high association of this entity with gallbladder cancer (30-70%).
Although nausea, bloating, heartburn and nonspecific pain can be produced by gallstones, the best and most specific symptoms referable to gallstones are the three pain complexes noted above. In a study performed in Italy where an entire town had an ultrasound and filled out a questionnaire, 90% of the patients with the pain complexes had stones on ultrasound but only 50% of those with non-specific symptoms had stones. That is, those with non-specific symptoms, such as nausea, bloating or belching, were as likely to have stones as not and therefore as likely to benefit from treatment as not.