Medical Edge Newspaper Column

Most Patients with Cholecystitis Eventually Require Gallbladder Removal

October 16, 2009
Dear Mayo Clinic:
My 65-year-old mother has been diagnosed with acute cholecystitis. She had to spend several days in the hospital when she was first diagnosed, and her physician is recommending her gallbladder be removed. Is that really necessary? Are there other treatments options?

Answer:
Cholecystitis is an inflammation of the gallbladder. In most cases after a patient has had an attack of acute cholecystitis, removal of the gallbladder is recommended because cholecystitis frequently recurs as a result of gallstones. In some cases, treatment with medication to eliminate gallstones may be used instead of gallbladder removal. But this therapy is not as effective as surgery.

The gallbladder is a small, pear-shaped organ on the right side of the abdomen, just beneath the liver. The gallbladder holds fluid called bile that's releases after you eat — particularly after you eat high-fat foods — to aid digestion. Bile travels out of the gallbladder through a small tube called the cystic duct, to another tube called the common bile duct, and then into the small intestine.

Cholecystitis occurs when the gallbladder becomes inflamed. In some cases, cholecystitis may be caused by an injury, infection or tumor. But the vast majority of cholecystitis cases are due to gallstones that block the cystic duct, causing bile to build up and resulting in gallbladder inflammation.

An attack of acute cholecystitis can be very painful. Symptoms typically include severe, steady pain in the upper right part of the abdomen that, if left untreated, may last several hours or days, and gets worse when you breathe deeply. In addition, cholecystitis can cause pain that radiates from the abdomen to the right shoulder or back.

Other signs and symptoms of cholecystitis may include tenderness of the abdomen when it's touched, sweating, nausea, vomiting, loss of appetite, fever, chills and abdominal bloating. Cholecystitis signs and symptoms usually occur after a meal, particularly a large meal or a meal high in fat.

As in your mother's case, acute cholecystitis requires prompt medical attention that often includes hospitalization to effectively manage symptoms. Because this condition frequently recurs, most people diagnosed with cholecystitis eventually require gallbladder removal (cholecystectomy).

Cholecystectomy usually is necessary because acute cholecystitis attacks are related to gallstones that remain in the gallbladder after the attack has resolved. More gallstones may also form, and there's a significant risk that these stones will lead to future attacks of cholecystitis. The simplest and most effective way to eliminate gallstones, and the risk of cholecystitis, is to remove the gallbladder.

Gallbladder removal is most often performed via a minimally invasive operation called laparoscopic cholecystectomy. This procedure uses a tiny video camera to see inside the abdomen and special surgical tools to remove the gallbladder. The tools and camera are inserted through four small incisions in the abdomen, and the surgeon watches a monitor while guiding the tools during surgery.

The good news for your mother is that cholecystectomy is a common operation, and it carries only a small risk of complications. In most cases, patients can go home the same day they have surgery. Once the gallbladder is removed, bile flows directly from the liver into the small intestine, rather than being stored in the gallbladder. Some people experience mild diarrhea after cholecystectomy, though this usually goes away with time. Most people won't experience digestive problems after cholecystectomy, as the gallbladder isn't essential to healthy digestion.

If your mother has other significant medical problems that make surgery risky, medical therapy may be an alternative. Medications such as ursodeoxycholic acid may be given in an attempt to dissolve gallstones, but getting rid of stones this way can take months or years of treatment. Medical therapy may not be successful.

If your mother has questions about surgery or feels apprehensive about the procedure to remove her gallbladder, encourage her to discuss those concerns with her medical doctor or surgeon.

— Michael Picco, M.D., Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Fla.