Do Gallstones and Cholecystitis Always Require Gallbladder Removal?

Is gallbladder removal necessary for gallstones accompanied by cholecystitis?

Two weeks ago, I experienced pain on the right side of my abdomen and went to the emergency room.
Blood tests showed abnormalities: CRP: 162, Total Bilirubin: 1.5, Segmented Neutrophils: 80, Lymphocytes: 13, WBC: 21.
The emergency physician diagnosed me with gallstones and cholecystitis, recommending surgery to remove my gallbladder.
That night, I was scheduled for surgery, and I expected to wake up post-anesthesia with the procedure completed.
However, they informed me that the intubation was unsuccessful (possibly due to obesity?).
The next day, they performed a percutaneous cholecystostomy to drain bile and started continuous antibiotic injections.
Now, two weeks later, although I have been discharged, I am still living with a drainage bag.
A few days ago, I returned for a follow-up and asked the surgeon if I could remove the drainage tube and just monitor the gallbladder condition instead of proceeding directly to surgery.
The doctor advised that if there is inflammation, the surgical risk would be higher, and it is better to schedule the gallbladder removal rather than wait for inflammation to worsen.

I would like to ask:
1.
Is it standard practice to remove the gallbladder as the first-line treatment for all cases of gallstones with inflammation?
2.
The doctor suggested performing gallbladder removal along with a gastric sleeve surgery since the same instruments would be used, reducing the risk of anesthesia.
Would performing both surgeries together increase the risk?
3.
On the day of the percutaneous cholecystostomy, although I received local anesthesia, I experienced severe pain that made it difficult to speak and caused rapid breathing.
Is this an indication that the local anesthesia was insufficient (possibly due to excess adipose tissue preventing adequate penetration of the anesthetic)?

Zai jian le wo de dan~, 40~49 year old female. Ask Date: 2021/04/07

Dr. Chen Shidian reply Gastroenterology and Hepatology

Cholecystectomy is still recommended; please discuss any related issues with your attending physician.

Reply Date: 2021/04/07

More Info

When it comes to the management of gallstones and cholecystitis, the decision to remove the gallbladder is often influenced by the presence of symptoms, the severity of the condition, and the potential for complications. Based on the information provided, it appears that you have experienced significant symptoms, including elevated inflammatory markers and a diagnosis of cholecystitis, which typically indicates inflammation of the gallbladder due to gallstones.

1. Is gallbladder removal always the first-line treatment for gallstones with inflammation?
In cases of acute cholecystitis, surgical intervention is generally recommended as the first-line treatment. The rationale behind this is that leaving an inflamed gallbladder can lead to complications such as perforation, abscess formation, or chronic inflammation, which can complicate future surgical procedures. The standard approach is to perform a cholecystectomy (gallbladder removal) either during the same hospitalization or shortly after the acute episode has resolved. In your case, the initial plan was to remove the gallbladder, but due to complications during anesthesia, a drainage procedure was performed first. This is a common approach when the patient is not stable enough for immediate surgery.

2. Does combining gallbladder removal with gastric surgery increase risk?
Performing two surgeries simultaneously, such as a cholecystectomy and a gastric reduction procedure, can indeed increase the overall risk of complications. However, the decision to combine these procedures often depends on the patient's overall health, the surgeon's experience, and the specific circumstances of the case. The advantage of performing both surgeries at once is that it reduces the need for multiple anesthetic events, which can be particularly beneficial for patients with comorbidities. However, it is crucial to have a thorough discussion with your surgical team about the risks and benefits of this approach, considering your specific health status.

3. Was the pain during the drainage procedure indicative of inadequate anesthesia?
Experiencing significant pain during a procedure that is supposed to be under local anesthesia can be concerning. It may suggest that the anesthesia was not adequately administered or that the area was not sufficiently numbed. Factors such as body habitus (e.g., increased adiposity) can complicate the delivery of local anesthetics, potentially leading to inadequate pain control. If you felt pain severe enough to cause distress, it is essential to communicate this to your healthcare providers, as they can adjust their techniques or medications in future procedures to improve your comfort.

In conclusion, gallstones and cholecystitis often necessitate gallbladder removal, particularly when symptoms are present. While combining surgeries can be beneficial, it is essential to weigh the risks carefully. Pain during procedures should always be addressed to ensure adequate management in the future. It is advisable to maintain open communication with your healthcare team to make informed decisions about your treatment plan. Regular follow-ups and monitoring are also crucial to ensure that any complications are addressed promptly.

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