Unsure about laparoscopic cholocystectomy esp. regarding arrhythmias

[paravantis]

I am a 43 years old male, slightly overweight, borderline hypertensive, no medications.

5 years ago I suffered ONCE an (unknown) arrhythmia; I have since quit coffee etc but suffer from occasional PVCs which have been caught on Holter (about 200/day a couple of years ago) BUT fortunately get fewer with time -- I now only feel a couple every other day. (May have been partially been caused by anxiety over the arrhythmia.)

In the last 3 years, ultrasound findings of my gallblader progressed from "small quantity of sludge present" to "small quantity of sludge AND micro/small gallstones at the bottom of the gland and near its exit (?)" although the ducts are clean.

Note that parents and 48 years old sister have ALL had their gallblader removed!

A laparoscopy specialist I saw told me that the sludge and my (relatively young) age are two important factors in his recommending surgery (lap chole). He did NOT recomment any alternative treatments (lithotripsy, pills) and fears that if I do NOT remove my gallblader I may get pancreas problems before too long.

I would appreciate your valuable input on:

1. Do you agree that removing the gallblader is the best option? Please note that I am ASYMPTOMATIC.

2. Because of my PVCs (and that one arrhytmia) I confess I am a bit scared about the complications esp. arrhythmias. Your input? Any special precautions I should make sure are in place if I DO proceed with lap chole?

3. Other complications during lap surgery such as CO2 embolism? They do sound scary!

4. What about the risk of bile duct injury during surgery? The specialist I saw told me that these are a function of "expertise of the lap team and equipment" and he insists he and his team can handle it.

4. How likely is it that I may get chronic diarrhea after the surgery?

5. What about the increased risk of colon cancer that is reported in the net?

Thank you very kindly for making this forum available to us! It was this very forum that set my mind at ease a few years back when I posed a question on my PVCs in the cardio forum!

John P.

[paravantis]

An interesting follow up to my original question:

A second gallbladder ultrasound (done by doctor considered to be the local gold standard in ultrasound diagnostics) came up with ZERO STONES in my gallbladder! Instead, 4 "cholesterol deposits" (i.e. polyps as explained orally by the doctor) were located. These 4 deposits are small; the largest has a diameter of 6 mm and is located in the fundus of the gallblader.

Wow! I am now the proud holder of two VERY different ultrasounds!

Considering these findings, should I remove my gallbladder or watch and wait?

Thank you
John Paravantis

[farscape66]

To Surgeon,
Are you the only one that does this special procedure you spoke of? Anyone in the Washington DC Area that does it? Looking ahead to the future.

[farscape66]

I have a suggestion on avoiding Pancreatitus.  There is a urine test strip called chemstix 10 or multistix 10. This test covers bilibribum and urobilibrium.  These are elevated when a bile duct is blocked.  The urine also appears darker in color.  I use these test strips daily to watch for possible blockage.  I am alson not a good candidate for surgery right now.  
I recommend you try these test strips, they can help ward off a potential problem with the pancrease.  If you test positive, see your doctor.

[surgeon]

pancreatitis, when related to gallstone disease, occurs when a stone passes from the gallbladder and into the bile duct, and hangs up at the opening into the intestine. The panceas duct shares that opening, and if bile is forced into the pancreas, it can cause pancreatitis. For this to happen, the stones need to be bigger than the little bits you described. Pancreatitis can indeed be severe, and in rare cases life-threatening. Most people by far with gallstones don't get pancreatitis. Of those that do, it typically goes away very quickly, since the stone usually passes. So when a person gets gallstone pancreatitis it's definitley a reason to have gallbladder surgery. Again; no one has a crystal ball. The vast majority of gallstone owners don't get pancreatitis; the ones that do typically recover rapidly and get their gallbladder taken care of. So yes, it can happen. But in my opinion, it's not a reason to tell someone they need their gallbladder out when it's not symptomatic. One can only predict what will happen to large numbers of people; no one can predict what will happen to one individual. Good or bad.

[Kevin Pho, MD]

Hello - thanks for asking your questions.

Our surgical colleague has addressed most of the surgical-related issues, so I won't repeat them here.

One point that I would concur with is that I would not recommend surgery if you are asymptommatic.  

Regarding the association of cholecystectomy and colon cancer - there are several smaller studies that suggest an associate between cholecystectomy and proximal colon cancer.  This is still a controversial area.  An editorial from the American Journal of Gastroenterology regarding this topic can be found here:
http://www-east.elsevier.com/ajg/issues/9401/ajg754edi.htm

I believe that the rest of the questions were addressed by the surgeon.  

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Thanks,
Kevin, M.D.

[paravantis]

I wish to thank everyone who bothered to add their valuable input to my question.

Most of all I wish to thank the surgeon who provided his invaluable input to the issues I raised.

John P.

[surgeon]

No one has a crystal ball: no one can say if you would have trouble in the future if you left the gallbladder alone. But I have almost never recommended surgery in an asymptomatic patient. It's unlikely to go from no symptoms to severe complications without having some symptoms first. So I consider it safe to wait. However, it is possible to have a serious problem as the first symptom. Lithotripsy doesn't work on sludge or tiny tiny stones. Pills might help to prevent formation of actual stones, but you'd have to take them forever. If you have surgery, you should see your cardiologist first, or at least be sure the surgeon is in touch with her/him beforehand. CO2 embolism is extremely rare. No surgery is absolutely safe. All sorts of horrible things have happened with any surgery; same is true with walking across the street, or down the aisle of the supermarket. Diarrhea occurs in a small percentage of patients. If it does, it's usually easy to control with diet or occasional medicine. Some people have a big problem; not many. But that's one reason why I like to wait until symtoms: it makes it a better choice. In the hands of experienced surgeons, bile duct injury is very rare, but not impossible. I personally prefer what I call "minicholecystectomy" which is done with one small (1 1/2 inch, usually) incision instead of several smaller ones. Studies (done on people with bigger incisions than I make, but still quite small) have shown no difference in pain, return to work, etc, but fewer complications and much less cost with mini surgery than with laparascopic surgery. However, it's harder to do, and you won't likely find anyone who does it. Laparoscopy has won the PR battle. And it's a fine procedure, don't get me wrong.

[tessa0825]

Hi John, I had mine out a few months ago....If I had been asymptomatic I probably would not have....Im not 100% sure but I think alot of Drs. don't recommend removal until you do become symptomatic....Alot of people have gallstones that don't bother them and never do....However, once symptoms start then it usually goes down hill from there....I have not experienced the post diarrhea problem that some people have, Im not sure there is any way anyone can say if you would develop that problem or not....I do know that when biliary colic starts, Im not sure you have much choice in the matter, as you cant go through that type vomiting forever without causing damage other places.....Good luck....Tessa

[ConcernedGB]

Hello John P.,

I'm no doctor, but you've come to the right place!  Dr. Kevin and a surgeon who responds frequently to this page will definitely help you in addition to numerous others who have had GI problems.

Look through the posts on here and the pros and cons of laparoscopic cholesectomy have been debated quite a bit.  What I've gathered is that most people are glad to have had it done rather than those who regreted it.  Of course, no procedure is without risk.  But by and large, the benefits far outweigh the risks!

Also, don't be alarmed about reports of this procedure putting you at risk for colon cancer.  If that was true, then there would have been a sharp increase in the incidence of colon cancer since 1988, the year the procedure became available.  Rely on evidence-based practice.  I've gotten alarmed about alot of stuff on the Internet ranging from silver fillings giving people ALS to the dangers of Nutrasweet causing brain tumors.

About loose stools after the procedure, some have reported that, but changes in diet can help prevent that.  If it is any consolation, I plan to have my gall bladder out this fall!

Good luck!

[paravantis]

In my previous thank-you note I forgot to post this follow-up question to the surgeon.

The lap specialist I saw asserted that I may get pancreas problems if I wait and that this may be a life-threatening condition.

Would you please comment?