Gallstones - do I need surgery?

[alvaraalto]

Hello, I am a 39 year old male of normal weight and have experienced, in the last 16 months, three episodes of severe pain in the upper abdomen. The first two were (wrongly) treated with antacids. After the third episode, I did an ultrasound scan of the abdomen, which identified some gallstones (maximum size of 15 mm). The average size of the walls of the gallbladder is 4.5 mm. A CT scan of the abdomen, performed for different reasons, also highlighted a slight thickening of the walls of the gallbladder, although the gallstones were not visible through the CT scan. Eleven days after the painful episode, I had slightly elevated values of some enzymes (GGTP: 63 - Amylase: 166 - Lipase: 61.9) and an elevated CRP (11.7). 24 days after the episode my blood test was normal.

Following these tests, I was recommended to undergo laparoscopic cholecystectomy, which I am prepared to do, if necessary. However, my question is whether bile acid therapy should not be attempted first. I am asking as I am still young enough to safely carry out surgery a few months, or years later (should bile acid therapy fail) and given that the gallstones were not visible in the CT scan, potentially making them better candidates for bile acid dissolution. Moreover, I suspect my gallstones may have been the result of some previous fasting / rapid weight loss, which I will be careful to avoid in the future. Thank you in advance for your opinion on this.

[fntn]

No other options that I'm aware of other than the cholecystectomy. You probably have friends without their gallbladders as I do and most seem to have no real issues. Mine is usually filled with sludge and I'll probably be getting it removed at some point in the near future as well. Good luck.

[alvaraalto]

Thanks a lot. Ducts do not appear dilated in my scans. I discussed lithotripsy, but only briefly, and I understand the smaller fragments resulting from the procedure may cause complications. Doctors here think that the picture is fairly clear, and that my symptoms are in all likelihood caused by gallstones. And they seem to favour cholecystectomy as the best (or only) option for treatment (hence, my question).

[fntn]

Sounds like you're well informed about your condition, great! As you are probably already aware, a stone 1.5 cm isn't going to pass and dissolving/breakup or surgery are your choices. Is there any imaging that suggests that some of your small stones may have tried to work through your cystic duct or common bile ducts (any borderline dilations)? Obviously your 15 mm big boy isn't going anywhere. Did they mention that ultrasound can also be used to help break things up and speedup the dissolution process?

Certainly your call but if things do lead to acute cholangitis, you're not going to have much fun. And you are correct, an aggressive starvation diet could have set things into motion. But, wrt the inflamed gallbladder walls, the stones may have irritated things but are they suspicious something else maybe going on?