We don't post much about clinical topics here, mainly because we haven't done much practice since our medical training days. I'm primarily a researcher and professor. But every once in a while I see papers on subjects that strike a nostalgic chord from those days and yesterday was one of those once-in-a-whiles. This was a report of a paper (DOI: 10.3748/wjg.14.5282) about what we used to call "gall balls in the gall bag," that is, gall bladder disease from gallstones. My medical school was located at a gigantic hospital with a very famous surgical program. And the chief surgeon there was most famous for fixing other surgeon's gall bladder surgery mistakes. In those days there was no "interventional radiology" or laparoscopic surgery. The surgeon just opened up the patient and took out the gall bladder. Sometimes he (rarely she) screwed up and cut or produced an obstruction of the common bile duct or did something else even more terrible. Then the patient was sent to this big shot surgeon to get fixed. The surgery department did a lot of this, and the operations were often very long. Everything took place in the bottom of very small hole just under the rib cage, a hole that had to be held open with right angled instruments called retractors. Someone had to hold the retractors to keep the hole open. This didn't take a lot of skill. It's usually what I did. Once I fell asleep holding a retractor and was awakened by the surgeon whacking my gloved knuckles with some instrument. He also said something very impolite through his surgical mask. I hope he strained his voice (that's a joke).
Anyway, back to the paper. One of the old fashioned things I learned in those days of yore was that the typical gall bladder patient was "fat, female and forty." We've learned a lot about gall bladder disease (GD) since those days:
. . . since the introduction of laparoscopic cholecystectomy into clinical practice at the end of 80s, a possible unjustified increase in surgical procedures has been observed, probably due to changes in the perceived risk-benefit ratio (for patients and physicians [sic!]) and changes in surgical indications. Therefore, there is the need for more knowledge of the epidemiological characteristics of GD in order to better identify therapeutic strategies.A new research article addresses this question. The research team led by Prof. Davide Festi of the University of Bologna has performed the second phase of an epidemiological project (the MICOL project) which is a population-based, cross-sectional study carried out in 8 Italian regions by different operative units. (ScienceDaily)
The study looked at 5500 men and 4100 women first enrolled between 1985 and 1988. They were re-examined in 1995 to 1998 (after ten years). Gall bladder disease was diagnosed at the overall rate of .67%/ year, significantly higher in women (.81%) than men (.66%). Age was reported as a risk factor, although the odds ratios for age are around 3% per year. That doubles the odds in roughly 20 years, not a huge effect. These are results of a multiple logistic regression and no age specific rates are given, so we don't know if women in their forties are at special risk (it is the average value of the log odds that are being modeled as a linear increase with age, so it would be nice to see how well specified the relationship is, but alas we don't see the data). Women are indeed more prone than men to get GD. And Body Mass Index (BMI) is also a risk factor. So fat, female and at least forty probably still a good mnemonic (it was good enough for me to remember it for 40 years, anyway). The only symptom that was a decent sign of GD was pain in the pit of the stomach or under the right rib cage. Other symptoms often associated with GD were as likely to be other things.
Gall balls in the gall bag. Common. Painful. Expensive to society. And a part of my past I don't really miss. I hope they aren't part of my future.
Medicine & Health
Comments
It is so odd you write about this today. I spent the weekend in the hospital with my first gall bladder attack. It was less painful when I had my son, who weighed almost 10 pounds. Yesterday, I met with the surgeon, who is going to take it out in two weeks. He mentioned there are complications in about one out of every hundred surgeries. Is that what you found? Do you know the rate of being able to do the laparoscopic verses having the older way done due to complications during surgery? I am a bit nervous, because I have never had surgery before.
Posted by: DebP | September 24, 2008 8:08 AM
My wife had old-fashioned surgery in the early 90s, and it was no fun: ten days in hospital and lithotripsy to break up a stray stone in her bile duct. I had my gall bladder out in 2000, laparoscopically, and was home the next day, without even an LBJ-style scar to show off.
Posted by: Crawford Kilian | September 24, 2008 11:39 AM
Also had the laparoscopic gallbladder surgery back in 2001. My MD at the time decided that was the problem because of the pain under the right rib cage.
The pain under the right rib cage continues though and because of the digestive juices that flow from the gall bladder I really wish I had by gall bladder back.
It was interesting too as a day before the surgery the surgeon said to me, "are you sure you want the gall bladder out, I just did surgery on a guy who only needed his bladder lifted up as it was drooping and the pain stopped."
Interesting ... Geez. But I'm not getting anymore surgery, I've had enough and never enjoyed any of it.
BTW, I'm not fat now nor was I fat then.
Posted by: Lea | September 24, 2008 3:56 PM
DebP, I ain't the doctor but the laparoscopic is far less invasive and easier to handle. After I woke up and went in the recovery room I was out of there within eight hours and back home.
Don't be afraid. If you truly need the surgery get it. A distant relative of mine died at an early age because she didn't get gallbladder surgery. Dumb thing to die over.
Forgot to mention.
I've been diagnosed with Furniture Disease. My chest is falling into my drawers.
Posted by: Lea | September 24, 2008 7:15 PM
I had my gall bladder out on the same day the CardSystems Solutions data breach made the news: June 17, 2005. The surgery was laparoscopic, of course.
There wasn't much doubt about the diagnosis, when it finally arrived. I had been experiencing debilitating gastroenteritis from time to time for the three previous years.
The operation was fairly simple. But in my case, the side effect was the worst gas cramps I have ever had in my life. It was agonizing, and it took several weeks for me to get back on my feet.
Posted by: Charles | September 25, 2008 12:59 AM
I had the laparoscopic gallbladder surgery years ago, right when it first came out. It hurt like heck afterwards, but I'm sure it was a lot less pain than the full surgery, which my sister had about a decade before.
As for the "fat, female, forty?". I was fat, female but only 32. My sister was slim and 20. My doctor told me that having three kids in quick succession might have triggered mine.
I don't miss the gallbladder. Taking it out got rid of the nausea and pain.
Posted by: Bonz | September 25, 2008 2:39 AM