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Evaluate Gallstone Pain Before Surgery

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This figure might take you by surprise: almost 800,000 Americans a year have gallbladder removal surgery.

Called a cholecystectomy, the surgery is often called for when a patient has repeated gallbladder attacks which are marked by pain in the upper abdomen or chest from gallstones. Even though the surgery has become more high-tech and less invasive in recent years, it’s not a foolproof method for making your abdominal pain go away.

That is why it’s interesting to learn that a new study in the journal Clinical Gastroenterology and Hepatology suggests doctors make better assessments of a patient’s pain before going ahead with surgery. According to a summary of the journal article in ScienceDaily, as many as 50 percent of patients still report abdominal pain after a cholecystectomy.

“Given the number of cholecystectomies that are performed, this study underscores the importance of taking a detailed history when selecting patients for surgery,” said the lead author of the study, Mayo Clinic’s Dr. Johnson L. Thistle, in ScienceDaily.

By figuring out the frequency and duration of a patient’s gallbladder attacks, as well as the time of day they occur, physicians might get a better handle on who would benefit from gallbladder removal surgery. Also, the patient’s symptoms need to be differentiated from possible gastroesophageal reflux disease (GERD) or irritable bowel syndrome, Thistle said.

Gallstones, which resemble crystals or pebbles of digestive matter, can be as small as a grain of sand or as large as a golf ball. Gallstones can gather in the gallbladder by the hundreds, or maybe you will be the patient who has just one irksome gallstone.

Interestingly, though, most of the time gallstones do not cause any pain. They just happen to have been detected during some kind of imaging procedure.

“About 80 percent of gallstones never become symptomatic,” Thistle said.

For Thistle’s study, researchers looked at the records of more than 1,000 patients with upper abdominal pain who had elective cholecystectomy for uncomplicated gallstone disease. The patients who reported that the surgery made the gallbladder attacks go away shared all or some of these characteristics prior to surgery:

*pain occurred once a month or less
*pain lasted 30 minutes to 24 hours
*pain occurred during the evening or at night
*attacks of pain started one year or less before diagnosis

Whether your gallstones will cause pain sometimes depends on where they are in the gallbladder. If they are resting on the bottom of the pear-shaped gallbladder, they can probably be ignored. But if they have moved upward where they can block a duct opening, severe pain can occur.

If there is no pain, don’t worry about gallbladder removal, wrote Dr. John Poterucha, a Mayo Clinic gastroenterologist, in a Mayo website article. Just stay alert for possible gallbladder attack symptoms.

“If you have one gallbladder attack, however, you’re likely to have another one. If you have frequent attacks, your doctor will likely recommend that you have your gallbladder removed,” Poterucha said.

As for those 800,000 Americans a year who have their gallbladder removed, they can mostly count on no ill effects. Digestion can go on with or without a gallbladder.


“Pain Characteristics Suggest Higher Benefit from Gallbladder Surgery.” ScienceDaily. Web. 21 Dec. 2011. http://www.sciencedaily.com/releases/2011/10/111012124141.htm

Poterucha, John. “Gallstones Without Symptoms Don’t Require Treatment.” Mayo Clinic Medical Edge Newspaper Column, July 15, 2011. Web. 21 Dec. 2011. http://www.mayoclinic.org/medical-edge-newspaper-2011/jul-15b.html

Reviewed December 22, 2011
by Michele Blacksberg RN
Edited by Jody Smith

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