What are gallbladder polyps?
The gallbladder is a small sac which lies beneath the liver and acts as a reservoir to store bile. Bile is made by the liver and contains bile pigments, bile salts, lipids and cholesterol which are released into the duodenum (first part of the small bowel) to help digest fats.
Gallbladder polyps are growths that protrude from the lining of the inside of the gallbladder. Roughly 4-6% of the population have gallbladder polyps and are found by accident when investigating for other conditions. Polyps can be cancerous, but about 95% of gallbladder polyps are benign. The size of a gallbladder polyp can help predict whether it's cancerous (malignant) or noncancerous (benign). Small gallbladder polyps that are less than 10mm are unlikely to be cancerous and generally don't require treatment.
However, for these polyps, your doctor may suggest follow-up examinations to look for changes that may be an indication of cancer. This can be done using standard abdominal ultrasound or endoscopic ultrasound.
Gallbladder polyps that are 10 mm or larger are more likely to be cancerous or turn into cancer over time, and those larger 18 mm may pose a significant risk of being malignant. Treatment of larger gallbladder polyps includes surgical removal of the gallbladder (cholecystectomy). Again, malignant polyps are extremely rare.
Your doctor may also recommend cholecystectomy if you have a gallbladder polyp of any size accompanied with gallstones.
What causes gallbladder polyps?
It is unclear as to what causes gallbladder polyps, but malignant polyps are associated with an age >60 years, gallstones, and primary sclerosing cholangitis.
Diagnosis
Gallbladder polyps are most commonly diagnosed with an ultrasound scan of the abdomen. Gallbladder polyps usually do not cause any symptoms and are only discovered by chance while testing for other conditions. Sometimes however, patients can present with abdominal pain, nausea and an ultrasound scan may identify polyps that are actually small gallstones.
Your surgeon will decide on whether you are more likely to have gallstones when he takes your history.
Treatment
(See individual treatment pages for detailed description of operation)
Treatment of gallbladder polyps is usually with keyhole surgery to remove the gallbladder once the polyp has reached 10mm in size or if you have pain.
Laparoscopic Cholecystectomy (with on-table cholangiogram)
Laparoscopic Cholecystectomy is the recommended approach to remove the gallbladder. Surgery is performed under a general anaesthetic using four small incisions. All surgery is performed inside the abdomen with the entire gallbladder containing the polyp is removed.
The advantages of laparoscopic approach include:
- Less postoperative pain
- Reduced hospital stay
- Quicker physical recovery
- Less wound scarring
Occasionally as happens in 3-5% of patients, it may not be possible to complete the procedure using the keyhole approach. The operation will therefore be converted to an open procedure. Your surgeon will discuss this with you prior to surgery.