question-icon

Is laparoscopic cholecystectomy effective and reliable in acute cholecystitis?

default
Posted on Thu, 21 Jul 2016
Question: I am a Scientist in XXXXXXX My mother gallbladder is normal in size and shape and echogenic focus of size 7.9 mm.

She is 75 years of age.

Doctors has advised to remove Gallbladder through Leproscopic surgery.

Please advise if with leproscopic surgery can it be removed.

Thanking you

Yours sincerely

XXXX

Whether without going Leproscopic surgery treatment can be done ?
doctor
Answered by Dr. Shuba Hariprasad (3 hours later)
Brief Answer:
Laparoscopic removal if growing

Detailed Answer:
Hello XXXX,

Thank you for your query.
I'm Dr. Shuba Hariprasad and will be answering your query today.

Echogenic foci usually indicate a polyp (fleshy growths).
These can vary in size and number.

-does she have any symptoms? Abdominal pain, discomfort after meals, nausea, altered bowel habits?
-any weight loss?
-any other medical conditions? Medications?

A polyp can be benign (non cancerous) in 95% of the cases.
Size of the polyp is a reasonably good indicator to assess risk of the polyp being cancerous. XXXXXXX women are known to be at a higher risk of developing cancerous polyps.

Other criteria (where it is located, whether it is adhered or stuck to the wall) also play a role in assessing the type of polyp.

However, since the size is only 7.9mm, it is possible to wait 3 more months to recheck the size and see if it is growing or not.

If it is not growing, repeat another scan in 3 months and if still no change, repeat in 6 months.

If it is growing or if there are suspicious characteristics in the ultrasound, it is advisable to have it removed.

Yes it can be removed laparoscopically with minimal risk if your mother has no other medical conditions.
This risk will be assessed prior to surgery and adequate precautions will be taken to minimize risk of serious complications after they have informed you and obtained your consent.

Although, it sounds scary, the chance of malignant polyp is less than 5%.

Unless symptomatic or the type of polyp is known, there is no treatment except for removing it.
If it is a cholesterol polyp, medications and diet modifications to reduce cholesterol levels can help prevent further development of these polyps.

Hope this helps.
Please let me know if there is anything else I can help you with.

Wish you and your mother the best of health.
Regards,
Dr. Shuba Hariprasad
Above answer was peer-reviewed by : Dr. Priyanka G Raj
doctor
default
Follow up: Dr. Shuba Hariprasad (3 hours later)
Thank you Doctor
I am submitting the reports I got

Please advise whether we have to remove Gallbladder or wait for automatic removal of disease.

Thank you very much

XXXX
Scientist
Defence R&D organisation
New XXXXXXX
doctor
Answered by Dr. Shuba Hariprasad (4 hours later)
Brief Answer:
Further testing required

Detailed Answer:
Hello,
Thank you for the follow up.
I've gone through the reports.

The report only suggests that it may be a polyp. A CT or an endoscopic ultrasound may be required to give more details of the gall bladder, the polyp and the surrounding structures.

My recommendations remain as suggested in my previous reply.
If you could give me clarifications to the questions I asked earlier, I could help you further.

As for the gall bladder removal, a presence of a growth, it's associated symptoms, size and characteristics will decide if a surgery is required or not.

If there is a moderate to high degree of suspicion of malignancy (based on medical history, family history, current symptoms, blood tests), it is advisable to remove the gall bladder.

If not, close monitoring with regular imaging such as endoscopic ultrasound or CT scan should be done to check for increase in size and other characteristics (as mentioned previously)

I would recommend
- a CT scan and/or endoscopic ultrasound to confirm the presence of the polyp and it's characteristics
- blood tests (complete blood count, liver function tests, carcino embryonic antigen, CA 19-9, kidney function tests)
-urine analysis, stool routine
-a gastroenterologist consult.

The ultrasound report may be enough for some doctors to advice surgery based on the risk of developing malignancy.
7.9mm is borderline. This may or may not be cancer.
Based on the scan alone, I would wait and repeat a scan and do a more detailed scan (as mentioned above) and other tests as well (mentioned above).

However, scan alone is not enough, please get back to me with the clarifications for my earlier queries.

Wish you both good health.

Regards,
Dr. Shuba Hariprasad


Above answer was peer-reviewed by : Dr. Prasad
doctor
Answered by
Dr.
Dr. Shuba Hariprasad

General & Family Physician

Practicing since :2002

Answered : 1087 Questions

premium_optimized

The User accepted the expert's answer

Share on
Is laparoscopic cholecystectomy effective and reliable in acute cholecystitis?

Brief Answer: Laparoscopic removal if growing Detailed Answer: Hello XXXX, Thank you for your query. I'm Dr. Shuba Hariprasad and will be answering your query today. Echogenic foci usually indicate a polyp (fleshy growths). These can vary in size and number. -does she have any symptoms? Abdominal pain, discomfort after meals, nausea, altered bowel habits? -any weight loss? -any other medical conditions? Medications? A polyp can be benign (non cancerous) in 95% of the cases. Size of the polyp is a reasonably good indicator to assess risk of the polyp being cancerous. XXXXXXX women are known to be at a higher risk of developing cancerous polyps. Other criteria (where it is located, whether it is adhered or stuck to the wall) also play a role in assessing the type of polyp. However, since the size is only 7.9mm, it is possible to wait 3 more months to recheck the size and see if it is growing or not. If it is not growing, repeat another scan in 3 months and if still no change, repeat in 6 months. If it is growing or if there are suspicious characteristics in the ultrasound, it is advisable to have it removed. Yes it can be removed laparoscopically with minimal risk if your mother has no other medical conditions. This risk will be assessed prior to surgery and adequate precautions will be taken to minimize risk of serious complications after they have informed you and obtained your consent. Although, it sounds scary, the chance of malignant polyp is less than 5%. Unless symptomatic or the type of polyp is known, there is no treatment except for removing it. If it is a cholesterol polyp, medications and diet modifications to reduce cholesterol levels can help prevent further development of these polyps. Hope this helps. Please let me know if there is anything else I can help you with. Wish you and your mother the best of health. Regards, Dr. Shuba Hariprasad