cholecystectomy

[wolffs5]

I have had upper right quadrant pain for going on 2 years now.  The pain has become more constant in the past 6 months.  It burns into my back & shoulder blade so bad I have to hold my breath some times. I am tender under the right rib cage and if I sneeze or cough it hurts.  Sometimes if I breath in to deep it hurts. When I eat I get what feels like contractions within a half hour to 45 minutes of eating, which usually eases up in a couple hours.  I am passig real yellow & oily stools. Sometime there is oil floating in the toliet. I am now to the point I wake up sweating and my whole right side hurts, especially my back, I'm literally hunched over. My GP is 100% sure it's my gallbladder.  I have no insurance and am now on public aid. About 6 months ago I went to the ER because it hurt so bad.  THey refered me to a GI Specialits who ran me threw a bunch on blood tests, a endoscopy, a sigonoscopy, 2 ultrasounds, stool sample and a Hida scan.  They basiclly told me they can't find anything wrong and that is probably IBS.  The HIDA scan came back at 42%.  But I did react to the fatty meal.  My GP said that this was enough evidence for him that it is biliary dyskinesia and my gallbladder needs to come out.  Here's my problem I can't find a surgeon who will take public aid.  How much does it usually cost for a lap cholecystectomy?  And do you believe this could be my problem?

I'm sorry it's so long I need advice. I have three kids under 9 and they need Mom! And Mom is sick of telling them she doesn't feel good.

Thank You,
Lori

[Kevin Pho, MD]

Hello - thanks for asking your question.  

A biliary ejection fraction of lower than 35% is considered abnormal. In some cases, this may be associated with Sphincter of Oddi dysfunction (SOD). In any case, a low biliary ejection fraction predisposes you for gallstone formation in the future. The decision for a cholecystectomy should be made in conjuction with your personal gastroenterologist and surgeon.

Other causes of right upper quadrant pain includes hepatitis, cholecystitis, cholangitis, pancreatitis, pneumonia, sub-diaphragmatic abscess or peptic ulcer disease/gastritis.  It is apparent you have undergone a battery of GI tests.

If you are passing greasy stools, perhaps tests for malabsorption (i.e. tests for fecal fat) may be in order.  

You may also want to consider tests for non-GI causes of pain - for instance CT imaging for abscesses or an abdominal aneurysm.  

There is also something known as painful rib syndrome that may be considered. The painful rib syndrome is an increasingly common condition characterized by discomfort in the lower chest or upper abdomen, tenderness over the costal margins, and reproduction of the pain by pressure on the ribs. This syndrome accounts for as many as 3 percent of new referrals to surgeons for the evaluation of upper abdominal pain. It is most common in women. The syndrome has a benign outcome and is important to recognize and diagnose to avoid unnecessary testing and treatment and to provide reassurance to the patient. In one review, 8 of 76 patients underwent noncurative cholecystectomy.

From a Department of Defense study, it was suggested that the cost of a laparoscopic cholecystectomy was $3959:
http://www.afip.org/Departments/legalmed/openfile95/lapcholereview.pdf

I strongly suggest that you continue to follow up with your personal physician.  

I stress that this answer is not intended as and does not substitute for medical advice - please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[surgeon]

biliary dyskinesia is hard to diagnose. It's possible that's what you have: but the tests you describe don't really confirm it. If you have the surgery, you'll have to accept the idea that there may be less than a 50-50 chance it'll help.