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Is surgical removal of gallbladder necessary?

Q: My 15 years old son has moderate pain in his upper stomach for the last 2 weeks and has been diagnosed with a single gallstone. Ultrasonography (USG) showed the size of the stone as 14 mm but magnetic resonance cholangiopancreatography (MRCP) showed it 4 mm. The stone is at the neck of gallbladder (GB). The doctor has advised for surgical removal of gallbladder. Later on, he has been put on Ursocol 300 mg for 3 months. What are the chances of gallstone dissolving by the drug given? Even if the stone will dissolve, would the GB return to normal functioning? What are the chances of recurrence of gallstones? Is surgery advisable?

A:From the details that you have provided, it appears that your son had one episode of biliary colic. You have mentioned that the USG showed a stone at the neck of gall bladder. In a young male with a documented attack of biliary colic due to stone in gall bladder, it is recommended that the gall bladder should be removed. The surgery is done by laparoscopy, and it is very safe. If left alone, the stone is likely to cause problems in future such as recurrence of pain, it can slip out & obstruct the bile duct, or may also cause pancreatitis. Ursocol is beneficial and may dissolve a small stone when taken over a long time. But the underlying gall bladder is diseased. So, considering the significant benefits, and very low risk of surgery, my advice is that laparoscopic cholecystectomy should be done.

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