Laparoscopic cholecystectomy—removal of the gallbladder through minimally invasive surgery—is standard treatment for patients with gallstones and abdominal pain. But up to 40 percent of patients experience pain after surgery, and a 2019 study in the Lancet suggests this surgery may not be warranted in every case.
Noting that there is no standard diagnostic strategy for selecting patients for surgery, researchers randomly assigned 537 patients to usual care—surgery at the discretion of the surgeon—and 530 patients to a restrictive strategy, where surgery was considered only if the patient met the following five criteria: severe pain, pain lasting 15 to 30 minutes, pain radiating to the back, pain in the upper or right upper quadrant of the abdomen, and pain responding to medication.
The restrictive strategy didn’t appear to be better than usual care at identifying patients more likely to benefit from surgery. At 12 months, about 40 percent of the patients in both groups still had abdominal pain. In the restrictive strategy group, 68 percent underwent surgery, compared with 75 percent of those in the usual care group, suggesting surgery isn’t always necessary.
Both surgeons and their patients should be aware that cholecystectomy does not always relieve pain, and should discuss whether surgery is the best option. However, patients with acute gallbladder inflammation, bile duct inflammation, or gallstone-induced pancreatitis need surgery.