Gallbladder polyp surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Clinical decision-making for gallbladder polyps is rather straightforward since the options include surveillance versus cholecystectomy.

Cholecystectomy should be considered in patients with polyps greater than 15 mm and smaller polyps that are sessile or found in patients with PSC. If the polyp is less than 15 mm and surveillance is the management of choice then re-evaluation should occur every 3-6 months because some studies suggest that polyps can increase in size 4-fold in 12 months.

If the rate of growth is nil, then surveillance can be stopped after 2 years.

If cholecystectomy is the treatment plan then one should consider the benefits of open versus laparoscopic cholecystectomy. Sentiment exists that laparoscopic cholecystectomy should not be performed if there is evidence of cancer because laparoscopic gallbladder cancer surgery is often complicated by port-site recurrence.

In one study, 16 patients with gallbladder polyps followed for 4 years had no recurrence. If the specimen demonstrates cancer that invades the muscular wall then radical cholecystectomy should be performed.

When selecting cholecystectomy over surveillance, it is important to know the complications of cholecystectomy.

• In a large study of nearly 23,000 cholecystectomies, the local complication rate was 7%.

• Systemic complications were observed in 2.3% of patients. Bile duct injury occurred in 0.3% of patients. Factors important in the outcome include body mass index, male gender and surgeon experience.