From the Guidelines
Porcelain gallbladder should be managed with prophylactic cholecystectomy due to the increased risk of gallbladder cancer, as suggested by guidelines for the treatment of gallstones 1. The condition is characterized by calcification of the gallbladder wall, giving it a bluish discoloration and brittle texture resembling porcelain.
Key Considerations
- The calcification process is thought to result from chronic inflammation of the gallbladder, often associated with gallstones.
- Patients with porcelain gallbladder are often asymptomatic, with the condition typically discovered incidentally during imaging studies performed for other reasons.
- The historically reported association between porcelain gallbladder and gallbladder cancer supports the recommendation for prophylactic cholecystectomy, although recent studies suggest this risk may be lower than previously thought, particularly in cases with partial calcification.
Management Approach
- Following diagnosis, patients should be referred to a surgeon for evaluation, and preoperative testing including liver function tests and appropriate imaging should be completed.
- Cholecystectomy is preferably performed via a laparoscopic approach when feasible.
- After cholecystectomy, patients should follow a normal diet but may initially experience some digestive changes as the body adapts to the absence of the gallbladder.
- Regular follow-up is recommended to monitor for any complications or symptoms. The guidelines for the treatment of gallstones suggest that patients with a high risk for gallbladder cancer, such as those with calcified gallbladders, should be considered for prophylactic cholecystectomy 1.
From the Research
Definition and Symptoms of Porcelain Gallbladder
- Porcelain gallbladder (PGB) is commonly referred to as gallbladder calcification, which is usually asymptomatic 2.
- Chronic inflammation of the gallbladder can occur as a result of another underlying condition, specifically gallstone disease 2.
- Patients with PGB may experience intermittent pain in the right upper abdomen 2.
Association with Gallbladder Cancer
- There was a belief that PGB had a correlation with gallbladder cancer, with an incidence rate of 30% 2.
- However, recent studies have indicated that the rate is only 5%-22% 2.
- A study found that none of the patients in the surgery group had gallbladder cancer on pathology review, and none of the observed patients developed gallbladder cancer during follow-up 3.
Management and Treatment
- Patients diagnosed with PGB, who are deemed to be at an elevated risk of developing cancer, may undergo prophylactic cholecystectomies 2.
- However, recent research indicates that a subset of these patients may potentially avoid this surgical intervention 2.
- Laparoscopic cholecystectomy is now a choice for patients with PGB, despite the increased risk of gallbladder cancer and the difficulty of holding and retracting the gallbladder 2, 4, 5.
- Single-incision laparoscopic cholecystectomy (SILC) has been performed in patients with PGB with a successful outcome 5.
- Prophylactic cholecystectomy is not routinely recommended in all patients with porcelain gallbladder, especially asymptomatic patients 3, 6.
Risk Factors and Complications
- PGB is associated with high risk of postoperative complications 3.
- The management of patients with PGB should consider three essential factors: symptoms or complications of gallbladder disease, calcification pattern, and patient age and comorbidities 6.
- Patients who do not undergo cholecystectomy should be educated about the symptoms of gallbladder diseases, and a thorough discussion is essential between patients and clinicians 6.