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Taken CA reading, had gallstone, recommended removal of gall bladder. If MRI is fine, should we go ahead with removal of gall bladder?

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My wife is 41 years old. Her 1st reading of CA 19.9 was 39 U/ml. A month later, she did another test and the reading was 41. She has gallstone and our doctor has suggested for the removal of the gallbladder because that could be the cause of the higher reading in CA. And he also said that there could be possibility of gallstone leading to gall bladder cancer or even liver cancer due. We are going for MRI test tomorrow on her abdomen. Just want to know if the pancreas checks out fine, should we go ahead with the removal of the gallbladder?
Posted Tue, 22 May 2012 in Abdominal Pain
Answered by Dr. Poorna Chandra K.S 10 hours later
Hi and thanks for the query.

Gallstones if symptomatic definitely requite surgery. The idea is gallstone related problems start with simple pain and complications may occur later. Asymptomatic gallstones with gallbladder wall thickening or with an impaired gallbladder function are also better operated upon.

Sometimes surgery may also be offered in patients with a family history of gallbladder cancer or if the prevalence of Gallbladder cancer is high in that locality. Elective surgery to avoid a difficult surgery later can also be considered in transplant recipients.

In people with repeated cholecystitis i.e. gallbladder inflammation, there is a small chance of development of gallbladder cancer. Liver cancers have no defined relation to gallstones.

The rise in ca 19.9 is not very significant and can represent lab variations also. It could also mean biliary inflammation.

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Follow-up: Taken CA reading, had gallstone, recommended removal of gall bladder. If MRI is fine, should we go ahead with removal of gall bladder? 14 hours later
Hi Doc
Thank you for the explanation. The MRI (with XXXXXXX contrast) results did not indicate anything wrong with the pancreas. However, it pointed to the thickening of the gallbladder wall because of the gallstones.
I noticed you mentioned gallstones if symptomatic requires surgery BUT my wife has not been complaining of any chronic pain/discomfort at her right abdomen (below the chest) NOR any indigestion experiences. How do you define symptomatic? In fact, her appetite has been better than ever for the past 1 year (she gets hungry fast for snacks in between meals; maybe it is a habit).
If I am not mistaken, in her last ultrasound scan which was done about 6 months ago, it revealed about two stones (cluttered together) measuring between 3 to 5mm. There was also fatty liver ( and mild thickening of the liver wall)
Our concern is IF WE GET THE GALLBLADDER surgically removed, my wife's body would have to adjust (without a gallbladder!) and there could be chronic complication or future side effects. How important is the gallbladder (our doctor told us it is just to store excess bile, and bile is produced by the liver)? My wife's regular diet strictly does not include red meat, and she eats only white meat, selectively on fish, once-in-a-while shrimps, and mostly vegetables and fruits.But she loves chocolates and potatoe chips, ice creams, deep-fried food, Coke, etc. Since we are Asians, rice and noodles will be a regular every day.
We totally understand that there is risk in any surgery regardless of how minor it could be. However, we are worried if left alone, could the gallstone and the gallbladder thickening transgress to more severe conditions such as gallbladder cancer, cirrhosis or even blockade in the common/cystic duct? We have also heard that without a gallbladder, excess bile will directly flow/"spill" into the pancreas and in the long run, this could cause the inflammation of the pancreas leading to pancreatic cancer?
Or perhaps, we should just keep a close watch of the gallbladder and the stone by doing frequent ultrasound+MRI scanning, say every 3-4 months? If the scans do continue to suggest wall thickening of either the gallbladder, liver or duct blockade, then we will do the surgery (Laparoscopic). Now of course, if persistent acute pain occurs at her abdomen, then we will do the surgery right away.
Lastly, is there any other way to treat the gallstone without having to go through surgery? We have tried the home therapy ONCE which involves the "lemon-green apple-olive oil drink" but the stones are still there. Should we continue to do it a few more times?
We have also heard there is this latest technological surgery/procedure which could remove the gallstones without having to remove the gallbladder? Advisable?
Thank you so much

Answered by Dr. Poorna Chandra K.S 17 hours later

Thanks for writing back.
Gallstones form as a result of 1) supersaturated bile secreted by liver and 2) prolonged stasis of bile in gallbladder leading to crystallization. Hence a gallbladder has to be defective to allow stone formation and removing only gallstones without the gallbladder will only lead to recurrence. As of today, the standard of care is removal of gallbladder itself.
Normally gallbladder functions to concentrate the bile and this function is taken over by the bile duct after surgery. Gallbladder surgery is the third most common GI surgery performed and is very safe with an adverse effect rate of < 1%.
Gallstones can lead to gall bladder cancer in an extremely small percentage of cases. However, pancreatic cancer is not a known complication of cholecytectomy.
As such, pancreatic cancer is not a known complication of removal of the gall bladder.
The efficacy of home remedies cannot be commented upon as there are no validated trials evaluating the same.
Removing just the gallstones and not the gall bladder itself, can lead to a recurrence and thus is not advisable.
Surgery on the gall bladder in asymptomatic gallstones is done if there is gallbladder wall thickening or if gallbladder function is impaired.
I would suggest that your wife gets her surgery done.
Wishing you the very best.

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Follow-up: Taken CA reading, had gallstone, recommended removal of gall bladder. If MRI is fine, should we go ahead with removal of gall bladder? 2 days later
Hi Doc, thanks again for the excellent explanation. We will definitely give a serious thought to your suggestion.
To be honest, I and my wife have this phobia about invasive treatment/surgery such as gallbladder removal. What is your opinion about Lithotripsy? The reason we are asking is because there is a few gallstone medical centers in Singapore (which is nearby to our hometown) which has the expertise and equipment to perform the lithotripsy.
We are thinking about doing the lithotripsy and then after my wife recuperates, putting her on an intensive fitness program including selective diet to avoid the recurrence of the stones.
Answered by Dr. Poorna Chandra K.S 14 hours later
Hi and thanks for the follow up.

As I had written earlier –

1)     As of today removal of gallbladder is the standard of care for gallstone related problems

2)     Lithotripsy is used in renal stones and in pancreatic stones. It is not a standard treatment with acceptable side effects and long term results

3)     Leaving behind a diseased gallbladder makes your wife prone to a risk (even-though it is less than 5-7%) of gallbladder cancer and recurrence of stones.

4)     Laproscopic gallbladder surgery is one of the commonly performed surgeries and has less than 1% risk of complications.

If she is not symptomatic you could electively choose the timing of the surgery, but if you resort to lithotripsy alone you should understand the risks involved.

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