Gallbladder Polyp; When Surgical Treatment is Necessary?

Year 2020, Volume: 6 Issue: 3, 369 - 375, 31.12.2020

İsmail Aydın , Selçuk Göktaş

https://doi.org/10.19127/mbsjohs.784868

Abstract

Objective: Gallbladder polyps (GBP) are the lesions that are originated from the mucosa of the gallbladder and reach out to the lumen. The biological behaviours of GBP have still been uncertain, their follow-ups and treatments are controversial as they carry the risk of malignancy. Our aim is to present the results of patients who have been operated on with the diagnosis of GBP in this study.
Methods: This retrospective study was conducted at Department of General Surgery, Giresun University. Patients who underwent surgery for GBP were included between January 2015 and December 2019. The age, gender, symptoms, ultrasonography findings (numbers polyps, types and presence of polyp and stone), surgery method (open and laparoscopic), and histopathological examination results were analysed.
Results: A total of 1486 cholecystectomies, including 1388 laparoscopic cholecystectomy and 98 open cholecystectomies, were performed. One-hundred thirty-two (8.8%) of these patients were operated with the diagnosis of the GBP. One-hundred thirty of them were operated with the laparoscopic method and two of them with the open surgical method. Overall, fourty two (31.8%) of the patients were male and 90 (68.2%) were female. The average age was 48.7. One-hundred one (76.5%) patients were clinically symptomatic. Gallstones were analysed in 35 (26.5%) patients. Multipl polyps were detected in 34 (25.8%) patients. There were no polyps determined in 47 (35.6%) patients the histopathological examination. The most common polyp type was cholesterol polyps (%64.8). Cancer histopathology was not found in any patient.
Conclusion: It is difficult to differentiate premalign and/or malignant lesions of the gallbladder from benign lesions. Therefore, we believe that surgical treatment is the correct approach for all GBP, which are symptomatic, accompanying stones, and that have a risk of malignancy ultrasonographically.

Keywords

polyp, cholecystectomy, Gallbladder

References

• Albores-Saavedra J, Chable-Montero F, Gonzalez-Romo MA, Jaramillo MR, Henson D. Adenomas of the gallbladder. Morphologic features, expression of gastric and intestinal mucins, and incidence of high-grade dysplasia/carcinoma in situ and invasive carcinoma. Hum Pathol 2012;43:1506-
• Cairns V, Neal CP, Dennison AR,Garcea G. Risk and Cost-effectiveness of Surveillance Followed by Cholecystectomy for Gallbladder Polyps. Arch Surg 2012;147:1078-83. Cha BH, Hwang J, Lee S, Kim J, Cho J, Kim H et al Pre-operative factors that can predict neoplastic polypoid lesions of the gallbladder. World J Gastroenterol. 2011;17:2216–2222
• Csendes A, Burgos AM, Csendes P, Smok G, Rojas J. Latefollow-up of polypoid lesions of the gallbadder smaller than 10mm. Ann Surg 2001;234(5):657-60.
• Dinc T, Coskun F, KutluKucuk O. Our surgical experience in gall bladder polyps. Gaziantep Med J 2013;19(3): 169-172
• Goetze TO, Paolucci V. Adequate extent in radical re-resection of incidental gallbladder carcinoma: analysis of the German Registry. SurgEndosc. 2010 Sep;24:2156-64.
• Jones-Monahan KS, Gruenberg JC, Finger JE, TongGK. Isolated small gallbladder polyps: an indication forcholecystectomy in symptomatic patients. Am Surg2000; 66: 716-9.
• Kwon W, Jang JY, Lee SE, Hwang DW, Kim SW. Clinicopathologic features of polypoid lesions of the gallbladder and risk factors of gallbladder cancer. J Korean Med Sci. 2009 Jun;24:481-7.
• Lee KF, Wong J, Li JC, Lai PB. Polypoid lesions of thegallbladder. Am J Surg 2004;188(2):186-90.
• Lin WR, Lin D-Y, Tai D-I, Hsieh S-Y, Lin C-Y, Sheen I-S et alPrevalence of and risk factors for gallbladder polyps detected by ultrasonography among healthy Chinese: analysis of 34 669 cases. J GastroenterolHepatol 2008;23:965-9.
• Lou MW, Hu WD, Fan Y, Chen JH, E ZS, Yang GF. CT biliarycystoscopy of gallbladder polyps. World J Gastroenterol2004;10(8):1204-7.
• Marangoni G, Hakeem A, Toogood GJ, Lodge P, Prasad R. Treatment and surveillance of polypoid lesions of the gallbladder in the United Kingdom. HPB (Oxford) 2012;14:435-40.
• Sarkut P, Kilicturgay S, Ozer A, Ozturk E, Yilmazlar T. "Gallbladder polyps: factors affecting surgical decision." World Journal of Gastroenterology: WJG 19.28 (2013): 4526. Shinkai H, Kimura W, MutoT. Surgical indications for smallpolypoid lesions of the gallbladder. Am J Surg1998;175(2):114-7.
• Sun XJ, Shi JS, Han Y. Diagnosis and treatment of polypoidlesions of the gallbladder: report of 194 cases. HepatobiliaryPancreat Dis Int 2004;3(4):591-4.
• Yongliang S, Yang Z, Lan X, TanH "Neoplastic polyps in gallbladder: a retrospective study to determine risk factors and treatment strategy for gallbladder polyps." Hepatobiliary Surgery and Nutrition8.3 (2019): 219.
• Xu Q, Tao L-Y, Wu Q, Gao F, Zhang F-L, Yuan L, et alPrevalences of and risk factors for biliary stones and gallbladder polyps in a large Chinese population. HPB (Oxford) 2012;14:373-81.
• Yildirim M, Erkan N, Yakan S, Boz A, Vardar E. Polyps of the Gallbladder: Retrospective Analysis of 33 Cases. Journal of ADÜ Faculty of Medicine. 2005; 6(1) : 27 - 30.
• Yuksel A,Coskun M, Turgut HM, Ozyıldız M, Yazıcıoglu MB, YıldızSY. Postoperative Histopathology Findings of Ultrasonographically diagnosed Gallbladder Polyp.Kocaeli Medical Journal 2016; 5;1:11-15
• Zielinski MD, Atwell TD, Davis PW, Kendrick ML, Que FG. Comparison of surgically resected polypoid lesions of the gallbladder to their pre-operative ultrasound characteristics. J Gastrointest Surg. 2009;13:19–25.