Cholecystectomy

Our Department of Orthopedics and Traumatology plans and applies the most appropriate treatment at the scientific level in the diagnosis and treatment of musculoskeletal system diseases, in cooperation and solidarity with the departments in our hospital, by taking advantage of the wide range of technology. Clients are informed in detail by our specialist physicians about treatment plans.

The cells in the mucous layer lining the inner surface of the digestive system grow where they are located and form a tiny lump called a polyp. Polyps can be seen in the entire digestive system at different rates. Gall bladder polyp is detected in 1.5-4.5% of all patients who undergo ultrasonography (USG) in polyclinics. The disease is more common in women at the age of 40. Although it is very rare in childhood, it requires additional examination when detected.

What are the Symptoms?

Nausea, vomiting, abdominal pain (an abdominal pain that starts from the upper abdomen and hits the back below the right shoulder blade), jaundice may be seen. However, people with gallbladder polyp usually do not have any symptoms and polyps are detected incidentally by abdominal USG performed for another reason.

Why and How Important Are Gallbladder Polyps?

True polyps (adenomatous polyps) are very rarely seen in the gallbladder. Most of the polyps in the gallbladder; cholesterol polyps (60%), adenomyomas (25%) and inflammatory polyps (10%), which do not contain cancer risk. Adenomas, which are true polyps in the gallbladder, constitute only 4-5% of all gallbladder polyps. However, it is this group that is important because they have the risk of cancer. 25% of adenomas become cancerous, and all adenomas larger than 12 mm carry cancer cells. In other words, 1% of all gallbladder polyps are at risk of becoming cancerous. The size and appearance of the polyp on USG can give an idea in determining the cancer risk of the cases. While the risk of cancer is 37% in lesions with a wide base and larger than 10 mm, the risk of malignancy is negligibly low in polyps with peduncles and smaller than 10 mm. If USG findings are suspicious, computed tomography and endoscopic ultrasonography can be used.

Should Anyone With Gallbladder Polyp be Operated?

The most important thing to decide when polyp is detected; Which group of patients will be operated on, and which should only be followed. Because; If we are to operate on all polyps, since only 1% of these cases have a risk of cancer, the remaining 99% will be operated unnecessarily. Therefore, it is necessary to know the risk factors in this regard and to determine the decision of surgery according to these risk factors. The factors that increase the risk of cancer in the polyp are that the polyp is larger than 1 cm, its broad base, rapid growth, and the person’s age above 50. With this information; If the polyp is symptomatic (pain, nausea, vomiting) or has caused additional problems (such as gall bladder inflammation, pancreatitis), it should be operated regardless of its diameter or other factors such as appearance. It is operated if there is an asymptomatic polyp larger than 1 cm. Although asymptomatic polyp is smaller than 1 cm; If it shows rapid growth during follow-up or has a solid and broad-based structure, or has three or more millimeter-sized polyps or gallstones with it, or if the person is over 50 years old, surgery should be recommended. Laparoscopic (closed) surgery of the gallbladder is the gold standard in these cases. However, in cases with a very high cancer risk and a lesion that has exceeded the sac wall in the preoperative examinations, open surgery can be performed depending on the situation. (I will talk about laparoscopic surgeries and their advantages in a separate article.) In cases other than this (most of the polyps are in this category), USG control every three or six months is sufficient, depending on the structure of the polyp.