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Q. Is gallbladder removal necessary for acalculous biliary dyskinesia?

Answered by
Dr. Noushif M
and medically reviewed by Dr. Vinodhini. J
This is a premium question & answer published on Mar 11, 2020

Hello doctor,

I would like an opinion regarding surgery for acalculous biliary dyskinesia. I have had RUQ pain and colic attacks for the past three or four years. Ultrasounds at the time showed no symptoms. Then I had a HIDA scan that showed 12% ejection fraction, so the doctor suggested surgery to remove the gallbladder, even without stones or anything. I declined. I modified my diet. The attacks became more sporadic, but last month I had an acute acalculous cholecystitis event.

An ultrasound showed some sludge and 3 mm wall thickening. Again, surgery was suggested and scheduled. But symptoms resolved within a week and I am completely asymptomatic now. I am really scared of having unnecessary surgery if I have no stones. What is the worst that can happen if I just decline surgery? I am afraid of having ongoing new indigestion symptoms post-surgery. I do not want new problems. I am really afraid.

Dr. Noushif M

General Surgery Medical Gastroenterology Surgical Gastroenterology


Welcome to

Since you had GB sludge with multiple attacks of biliary colic, the chances of getting a repeat attack are very high. Sludge or microlithiasis denote a dysfunctional gall bladder. It is always better to remove a dysfunctional gall bladder as it has a high probability of stone formation. All attacks need not be mild as you had. At times severe attacks may happen which need emergency surgery. There can be infectious episodes too. The next severe complication happens from secondary pancreatitis.

This microlithiasis are not easily picked up on ultrasound scans. So if you see the risks of retaining gallbladder and the advantages of surgery, the advantages overweigh the risks. I would definitely recommend a planned surgery before developing complications and ending up with an infection and unplanned surgery.

I hope this helps.

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Thank you doctor,

I looked up biliary microlithiasis and that it may be a possible cause of post-surgery complications. What are the chances of that occurring? This is why I am so scared of surgery. In any case, I understand the importance of surgery for my case and thank you for explaining it in detail.

Dr. Noushif M

General Surgery Medical Gastroenterology Surgical Gastroenterology


Welcome back to

Post-surgery microlithiasis is less common. It happens from sludge or stones in the bile tube. Usually, these come from the gallbladder. So if the source is out the chances of microlithiasis are less.

I hope this helps.

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