Gallbladder Polyps: Deciphering the Need for Surgery

Gallbladder polyps are growths that form on the lining of the gallbladder wall. Thankfully, the majority of these polyps, up to 95%, are benign. However, there is still a small but concerning 5% risk that they may transform into gallbladder cancer. So, when is gallbladder polyp surgery necessary? Read on to find out.

1. Understanding Gallbladder Polyps

Gallbladder polyps are essentially tumor-like lesions or pseudotumors that develop on the surface of the gallbladder mucosa. They originate from the gallbladder wall and protrude into the gallbladder's inner cavity. While people of all ages can develop gallbladder polyps, they are predominantly found in adults. The exact cause of gallbladder polyps remains unknown, but they are associated with factors such as age and the presence of gallstones.

Approximately 95% of gallbladder polyps are benign and often go unnoticed as they do not cause any symptoms. They are typically discovered incidentally during medical examinations. However, the remaining 5% may produce symptoms akin to those of gallstones, including pain in the right lower quadrant or above the navel, nausea, vomiting, bloating, slow digestion, and in some cases, acute complications such as gallbladder inflammation and bile stasis.

2. Determining the Need for Gallbladder Polyp Surgery

While the majority of gallbladder polyps are benign, the potential risk of them evolving into cancer cannot be ignored. Early detection and timely intervention are paramount for effective disease management.
Malignant gallbladder polyps often exhibit distinguishing characteristics compared to their benign counterparts. Extensive research has indicated that age plays a role in the progression of polyps to malignancy.

Therefore, in cases of abnormal polyps, the risk of malignancy is higher when:

• Polyps have a broad base (sessile polyps).
• Polyps are larger in size (over 10 mm).
• Multiple polyps are present in the gallbladder.
• Polyps demonstrate rapid, unusual growth, proliferation, or a significant increase in size and number over a short period.
• Polyps develop in individuals over 50 years old.
• Polyps cause symptoms and frequently lead to cholecystitis.
• Polyps are identified in people with primary sclerosing cholangitis or concurrent gallbladder stones.

Monitoring the progression of polyps and the symptoms they induce is crucial. In some cases, gallbladder removal may be considered to prevent the development of malignant polyps and cancer. However, the necessity for gallbladder removal depends on a physician's assessment. The decision to proceed with gallbladder removal is typically reserved for cases with a high risk of malignancy.

Generally, if gallbladder polyps are smaller than 10 mm, surgery is not immediately required. Instead, periodic follow-up examinations every 3-6 months may be recommended. Surgery becomes necessary if the polyps grow larger than twice their previous size, exhibit irregular shapes, spread their bases, or if clinical symptoms such as recurrent pain and fever suggest the possibility of malignancy.

Presently, gallbladder surgery is commonly performed using laparoscopic techniques, which minimizes health impacts. However, regardless of the surgical approach, digestive complications may still arise. The gallbladder stores bile to aid digestion by releasing it into the intestines during meals. After gallbladder removal, bile continuously flows into the intestines, potentially causing digestive issues like diarrhea, bloating, and indigestion. Diarrhea is the most common digestive complication. Therefore, post-gallbladder removal, dietary adjustments are essential, including reducing fat intake, increasing fiber from fruits and vegetables, and consuming smaller, more frequent meals.