Fewer gallbladder operations do not reduce pain

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Published: August 11, 2021

Fewer gallbladder operations for abdominal pain and gallstones seem a good idea, because a large proportion of patients still have symptoms one year after the procedure. Tailor-made treatment could reduce the number of patients who experience pain. However, this turns out not to be the case.

Of 100,000 people with abdominal pain who report to their general practitioner every year, about 30,000 are gallstone patients. The standard treatment for gallstones is removal of the gallbladder (cholecystectomy) via keyhole surgery. It is one of the most commonly performed operations, but the procedure is not always effective for pain. About a third of patients continue to experience abdominal pain after gallbladder removal.

Therefore it has been investigated whether it is better to select patients who do or do not benefit from such a gallbladder surgery prior to the procedure. Such a tailor-made approach would ultimately provide patients with the best treatment. The result is a decrease in the percentage of operated patients from more than 75 to 68 percent, but the number of patients who are pain-free after one year does not decrease. It may even lead to a small increase in the number of patients who still have pain.

We have to conclude that the restrictive approach does not solve the problem. There is a need for new research into which patient, with which type of symptoms, will benefit most from gallbladder surgery. This has led to a validated, online decision tool that can properly inform the patient and the surgeon about the chance that the patient will be pain-free after surgery. This will improve joint decision-making regarding the operation.