Immediate Surgical Consultation for Cholecystectomy
A 1.5 cm (15 mm) gallbladder polyp in an asymptomatic patient requires immediate surgical consultation for cholecystectomy, as this size represents the highest independent risk factor for malignancy regardless of other features. 1, 2, 3
Why Surgery is Indicated at This Size
Polyps ≥15 mm warrant immediate surgical consultation without exception, as this threshold represents a critical cutoff where malignancy risk becomes unacceptably high 1, 2, 3
Neoplastic polyps average 18.1-18.5 mm in size, compared to only 7.5-12.6 mm for benign nonneoplastic lesions, placing your patient's 15 mm polyp squarely in the high-risk category 1, 3
The European guidelines (ESGAR/EAES/EFISDS/ESGE) strongly recommend cholecystectomy for all polyps ≥10 mm in patients fit for surgery, and your patient exceeds this threshold by 50% 4
Surgical Approach Considerations
Laparoscopic cholecystectomy is the treatment of choice for this patient, assuming no preoperative imaging features suggest invasive malignancy 5, 6
If advanced imaging (contrast-enhanced ultrasound or MRI) reveals concerning features such as focal wall thickening ≥4 mm adjacent to the polyp or loss of the gallbladder-liver interface, consider open cholecystectomy with preparation for extended resection 1, 7
Surgical morbidity ranges from 2-8% (including 0.3-0.6% bile duct injury risk) and mortality from 0.2-0.7%, which is acceptable given the malignancy risk at this polyp size 1, 2
Pre-Surgical Imaging Optimization
Obtain contrast-enhanced ultrasound (CEUS) if available to better characterize the polyp and differentiate it from tumefactive sludge or adenomyomatosis before surgery 1, 2
Ensure the polyp is truly fixed and non-mobile (not tumefactive sludge, which would be mobile and layering) 1, 3
Critical Pitfall to Avoid
Do not delay surgery for surveillance imaging—68% of gallbladder cancers associated with polyps are detected within the first year after initial detection, and your patient has already crossed the threshold requiring intervention 3
Be aware that 61-69% of polyps seen on ultrasound are not identified at subsequent cholecystectomy, but this should not deter surgery at 15 mm given the high malignancy risk 1, 2