Pain characteristics suggest higher benefit from gallbladder surgery

According to a new study in Clinical Gastroenterology and Hepatology, better understanding of a patient's abdominal pain could help physicians know which patients will benefit most from surgical removal of the gallbladder. Clinical Gastroenterology and Hepatology is the official journal of the American Gastroenterological Association.

Nearly 800,000 gallbladder removal surgeries, or cholecystectomies, are performed annually in the U.S. at a cost exceeding $6 billion. Surgeries are often performed on patients whose gallstones are discovered via imaging tests after patient complaints of abdominal pain. Considering that abdominal pain persists in up to 50 percent of patients after cholecystectomy, physicians need a better way to determine who will benefit from surgery.

"Given the number of cholecystectomies that are performed, this study underscores the importance of taking a detailed history when selecting patients for surgery," said Johnson L. Thistle, MD, of Mayo Clinic and lead author of this study. "About 80 percent of gallstones never become symptomatic. Identifying the features of episodic gallbladder pain and differentiating them from symptoms of and should lead to improved and value for patients with abdominal pain."

Researchers prospectively studied 1,008 patients with upper abdominal pain who had elective cholecystectomy for uncomplicated . The following pain characteristics, especially if multiple, were most predictive of pain relief after surgery: episodic pain (usually once a month or less), lasting 30 minutes to 24 hours, occurring during the evening or at night, and onset one year or less before presentation.

Gallstones form in the gallbladder and are composed predominately of cholesterol, which has separated out of solution in bile and formed crystals, much as sugar may form in the bottom of a syrup jar. Gallstones may be as small as a grain of sand or as large as a golf ball, and the gallbladder may contain anywhere from one stone to hundreds. It is not entirely known why some people develop gallstones and others do not.

Many people with gallstones have no symptoms, and often, the are found when tests are performed to evaluate other problems. In this case, no treatment is usually recommended. When symptoms do arise, removal is the most widely used therapy.

More information: For more information on gallstones, please read the AGA brochure "Understanding Gallstones."

add to favorites email to friend print save as pdf

Related Stories

Gallbladder removed without external incisions

Jul 28, 2008

In April of last year, surgeons at NewYork-Presbyterian Hospital/Columbia University Medical Center made headlines by removing a women's gallbladder through her uterus using a flexible endoscope, aided by several external ...

First US surgery to compare NOTES vs. laparoscopy

Jul 07, 2010

As part of the only U.S. prospective multicenter clinical trial to compare natural orifice translumenal endoscopic surgery (NOTES) to laparoscopy, surgeons at the University of California, San Diego School of Medicine have ...

Recommended for you

Were clinical trial practices in East Germany questionable?

23 hours ago

Clinical trials carried out in the former East Germany in the second half of the 20th century were not always with the full knowledge or understanding of participants with some questionable practices taking place, according ...

Schumacher's doctor sees progress after injury

Oct 23, 2014

A French physician who treated Michael Schumacher for nearly six months after the Formula One champion struck his head in a ski accident says he is no longer in a coma and predicted a possible recovery within three years.

User comments