Is it advisable to perform cholecystectomy after successful ERCP senes removal from common bile duct. Investigating medical documentation we found that patient had 2 stones (7mm and 9mm) in gallbladder few years before. About month ago he is admitted to hospital due to abdominal pain and jaundice. Laboratory and radiological findings were sugesstibile for mild pancreatitis and after 3 weeks lab findings were normal. MRCP found two stones in distal part of commont bile duct so we performed successful calculi extraction by ERCP. Is it advisable to perform laparoscopic cholecystectomy of an "empty gallbladder" as an preventive measure. We consider that gallbladder has gallstone making potential.
Little scientific evidence is available regarding this specific context. However, even in cases of 'an empty gall bladder' cholecystectomy should be considered, especially as radio-occult microlithiasis may also form a risk factor for recurrent panceatitis. Naturally, presence of pro-lithogenic factors, such as hemolytic disorders, hormone replacement or familial cholestatic disease would make decision for cholecystectomy a lot easier.
Kind regards,
Completely agree with Dr. Bronswijk. Additionally, smaller stones may be underestimated.
Very interesting and a rare setting indeed. Thanks for sharing it. If I were, I feel that emergency is tided over and now, in absence of other history regarding the patient's habitat etc, I would tend to follow over and wait to study its natural history, taking care of prophylactic precautions like putting the patient on chenodeoxycholic acid 450 to 900 mg daily in divided doses, besides other supporting t/t like antibiotics, low fat deit, small frequent meals, avoid heavy work, high fibre deit, if obesity, consider reducing deit too, yoga and other light exercises to take care of destabilised internal milieu regarding disturbed lipid metabolism, etc. It would give us an opportunity to study its natural history. Thenafter get back to enlighten us in future. You will be doing an immence service to the surgical fraternity. Regards,
One more point to my previous reply: Having observed, if the patient develops symptoms relating to GB pathology, opinion can be reconsidered at any point in future in favour of surgery. Secondly billiary pancreatitis never progress to recurrent event in absence of billiary lithiasis. Lastly, we still have lot to understand about the true stimulus that excites pancratitis ib billiary lithiasis.
Cholecystectomy is recommended as the gallbladder even is empty but is a stone former , to prevent other attacks of biliary or pancreatic problems.
gall bladder that formed a stone ,will form a stone more and more
Natural history of GBs forming stones is that only about 10% GBs become symptomatic and unless a GB is symptomatic, it is recommended to leave them alone. But the equation in question is different. Sometimes in a very difficult GB, one has to take recourse to partial cholecystectomy of take out stones but leave GB in situ. What happens to such GBs? Any thoughts, please?
The gall bladder that form a stone is a deseased gallbladder. Bette to remove it
For what to do cholecystectomy, risk of future stone formation!!!, even so, as long as not all patients with gall stones need cholecystectomy, only symptomatic.
I fully agree to go for cholecystectomy to remove the stone forming diseased gall bladder except in high risk unfit patients
Totally agree to go for cholecystectomy! Only if patient is not fit for surgery I would go for close observation
Boris Tadic
Indeed this can be a clinical dilemma. One could argue that a sphincterotomy could offer some protection (against future episodes of biliary pancreatitis), but risk factors for stone formation should be addressed. How do you define an "empty gallbladder" - ultrasound, MRCP or EUS?
Definitely, a cholecystectomy, to prevent further attacks of pancreatitis.
Several studies addressed this question. None of them demonstrates statistically significant reduction of recurrent CBD stones if cholecystectomy was performed. So the recommendation for cholecystectomy in “empty” gallbladder, in order to decrease recurrent CBD stones, was not supported by evidence. However, interval cholecystectomy is usually recommended, because it eliminates the risk for further acute cholecystitis (estimated as 10-15% in 5 years). Generally, the decision is based much more on the traditions of the institution and personal opinions, rather than to strong evidence.
The patient had mild gallstone pancreatitis and two stones in the common bile duct which were dealt with ERCP. Laparoscopic cholecystectomy should be done in this patient as he/she is already symptomatic.
Functioning gall bladder with normal wall thickness can not be regarded as diseased gall bladder and potential for stone formation.Could be the primary cause of gall bladder stone formation was metabolic.
Dose cholecystectomy prevent the possibility of stone formation inside the CBD?
Cholecystectomy may be a preventive measure of new pancreátic relapses
Yes of course there is a possibility of stone formation in such gall bladder.but not to forget that gall bladders in general also has such a liability.So is it sense to remove the gall of all persons ????
I think waiting policy is more advisable ?
Thanks
It is difficult to say if the gallbladder must be removed in all these patients. Is better to analyze it individually
In my experience, I used to manage the empty gallbladder by expectant management, and found many patients revisited with some forms of biliary conditions e.g. pancreatitis cholangitis, or cholecystitis , I set to do LC ,and found that they have chronic cholecystitis or acute cholecystitis and/or bile sludge ,so empty doesn't mean empty it is undetectable by ultrasound, CT or MRI
after I have seen these patients , now in my practice I talk to the patient and let them decide and I just do accordingly
The final decission must be taken with consideration of several concomitant risk factors associated individualy
I had seen a few cases of fetal biliary pancreatitis. Although this risk is minimal, the only way to prevent this risk is to remove the GB. If you prefer to keep the GB, then you may need to follow your patient carefully during his life and do every efforts necessary to prevent the relapse biliary pancreatitis. For patients of old age or with surgical risk, cholecystectomy is not necessary.
I would certainly recommend cholecytectomy because gall bladder would at least contain mud or sludge and would induce recurrent pancreatitis.
A polyp and an infected common bile duct diverticulum was treated with ERCP before my cholecystectomy. The gall bladder was inspected and there was some biliary sand, no sand or sludge. Was this appropriate?
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