Gallbladder Polyps Recommended for Operation – SAD

Today, I was sad when I saw a seafarer patient who came in for a 2nd opinion.  He was recommended to have a laparoscopic cholecystectomy.  Ultrasound showed polyps 4 to 6 mm in size with no gallbladder wall thickening and patient is asymptomatic.  He was asked to prepare 120 to 160 thousand pesos for a laparoscopic cholecystectomy.

gb_polyps_lap_chole_2017may18

I am sad because I believe gallbladder polyps, especially those smaller than 1 cm and asymptomatic, need no operation.

I am sad  because I have been advocating a wait and see approach with no operation when not needed.

I have written several blogs on gallbladder polyps and have advocated against unnecessary operation, particularly for seafarers.

Gallbladder Polyps – Concerns of Seafarers and Others

Seafarer medical clinics which do not require operation for gallbladder polyps

Usual Clearance for Seafarers with Gallbladder Cholesterolosis

https://www.facebook.com/groups/1327847933955719/

Mission: Promoting the Health of Filipino Seafarers!



 

In an effort to reinforce my advocacy on no need for operation for gallbladder polyps, I searched again the literature today and I found this very important article.

http://pubs.rsna.org/doi/full/10.1148/radiol.10100273

Incidentally Detected Gallbladder Polyps: Is Follow-up Necessary?—Long-term Clinical and US Analysis of 346 Patients

Published in 2010

The management of GB polyps is currently influenced by concern for the presence or development of GB carcinoma.

In conclusion, we found no cases of GB malignancy in 346 patients.

Advances in Knowledge

•. The risk of gallbladder (GB) malignancy resulting from incidentally detected polyps is extremely low.
•. The risk of neoplasia in incidentally detected polyps is also extremely low, with none seen at diameters smaller than 7 mm.
Implication for Patient Care

•. Incidentally detected GB polyps measuring 6 mm or less require no additional follow-up.

Ergo, NO NEED FOR OPERATION (REMOVAL OF THE GALLBLADDER) FOR GALLBLADDER POLYPS – small ones and in asymptomatic patients

ROJ@17may18

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