The most important deciding factor for surgery is the presence or absence of symptoms related to the gallstone. It is common to pick up incidental gallstones on routine scans intended for other reasons. However, up to 80% of such gallstones are not producing any symptoms and are best left alone. For stones which are causing pain or discomfort, the current recommendation is surgical removal.
The reason for the above recommendation is essentially a balance between the potential benefit and harm with the surgical approach versus that of leaving the gallstones alone. If the benefit outweighs the risk, (as in gallstones causing symptoms) surgery is generally recommended.
One common challenge doctors face is attributing the symptoms to the gallstones to justify taking the surgical route. This is because problems such as gastritis, bloating and indigestion can some times mimic milder symptoms related to the gallstones. Having too low a threshold for surgery will risk over treatment and unnecessary complications. As such, many doctors may choose to watch over a period using medication until he or she is reasonable convinced the stone need to be taken out.
- Dr Quan
