By Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD and Dr Peter Swan MBChB, FRACS
Compass Surgical | MacMurray Centre, Auckland
This is the fourth article in our 8-part guide to gallstones and gallbladder surgery.
Most people have heard of gallstones. Far fewer have heard of gallbladder polyps.
Yet gallbladder polyps are a common reason for referral to a surgeon, particularly since ultrasound scans are being performed more frequently than ever before.
One of the most common questions patients ask after receiving an ultrasound report is:
“Do I need to worry about this?”
The answer is usually reassuring.
Most gallbladder polyps are harmless and never require treatment. However, some polyps do require monitoring, and a small number may lead to a recommendation for gallbladder removal.
Understanding the difference is important.
In Article 3 of this series, What Is Biliary Dyskinesia?, we discussed how gallbladder symptoms can sometimes occur even when no gallstones are present. Gallbladder polyps are another condition that may be identified during investigation of abdominal symptoms, although they are often discovered incidentally.
A gallbladder polyp is a growth projecting from the inner lining of the gallbladder.
They are usually discovered incidentally during an ultrasound scan performed for abdominal pain, indigestion or unrelated symptoms.
Many patients are surprised to learn they have a polyp because they often cause no symptoms at all.
In fact, most gallbladder polyps are found entirely by chance.
Usually not.
The vast majority of gallbladder polyps are benign.
Many are cholesterol polyps, which are small deposits of cholesterol within the gallbladder wall rather than true tumours.
These polyps carry virtually no risk of becoming cancerous.
The challenge is identifying the small minority of polyps that may carry a higher risk.
Further patient information about gallbladder disease and gallbladder surgery is available through Healthify NZ and the Royal Australasian College of Surgeons (RACS).
Yes.
Size is one of the most important factors when assessing gallbladder polyps.
Small polyps, particularly those under 10 mm, are usually benign and often require no treatment beyond observation.
Larger polyps deserve closer attention because the risk of significant pathology increases with size.
Current international guidelines commonly recommend considering gallbladder removal for polyps measuring 10 mm or larger, although individual circumstances remain important.
For patients considering surgery, Article 5 of this series explains what happens during laparoscopic gallbladder surgery and what patients can expect before, during and after the procedure.
Often they do not.
Many patients with gallbladder polyps have no symptoms whatsoever.
When symptoms are present, it can be difficult to know whether the polyp is genuinely responsible.
This is particularly important because many patients with abdominal symptoms also have other potential explanations such as reflux, gastritis, irritable bowel syndrome or gallstones.
Finding a polyp on an ultrasound does not automatically mean it is causing the problem.
Gallbladder removal may be recommended when:
The decision is rarely based on one ultrasound finding alone.
Instead, it is made after considering the scan, your symptoms, your overall health and your individual circumstances.
For many patients, observation is the most appropriate option.
This may involve:
Many small polyps remain completely stable for years and never require treatment.
No.
One of the principles we emphasise at Compass Surgical is that an abnormality on a scan does not automatically require an operation.
Some patients prefer definitive treatment.
Others are comfortable with surveillance.
In many situations, both approaches may be reasonable.
Our role is to explain the risks, benefits and uncertainties so that patients can make informed decisions.
Not every decision in medicine is black and white.
Gallbladder polyps are a good example.
Two patients with similar scan findings may make different choices depending on their age, health, risk tolerance and personal preferences.
Good surgical care is not about persuading someone towards an operation.
It is about helping them understand their options and choosing the path that best fits their circumstances.
At Compass Surgical, we believe treatment decisions should be guided by evidence, common sense and individual patient goals.
Our approach is built around:
For some patients, surgery is clearly appropriate.
For others, observation is entirely reasonable.
The important thing is understanding why a recommendation is being made.
If you would like to learn more about gallbladder surgery or discuss whether monitoring or surgery is the most appropriate option, visit the Compass Surgical Gallbladder Surgery page or arrange a consultation with one of our surgeons.
If you and your surgeon decide that gallbladder removal is the best option, the next question is often:
“What actually happens during the operation?”
In the next article, “What Is Laparoscopic Gallbladder Surgery?”, we’ll explain how keyhole gallbladder surgery is performed and what patients can expect before, during and after the procedure.
Are gallbladder polyps common?
Yes. They are a common finding on ultrasound scans and are often discovered incidentally.
Do gallbladder polyps cause cancer?
Most do not. The vast majority are benign.
Will I need surgery if I have a gallbladder polyp?
Not necessarily. Many small polyps can be safely monitored.
What size polyp is concerning?
Polyps measuring 10 mm or larger generally warrant specialist assessment and discussion regarding surgery.
Can a gallbladder polyp disappear?
Some small cholesterol polyps may change over time, but most remain stable.
If you have been told you have a gallbladder polyp and are unsure whether treatment is necessary, Compass Surgical can help.
Working alongside your GP and the multidisciplinary team at the MacMurray Centre , we provide personalised, evidence-based advice tailored to your circumstances.
Sometimes the right answer is surgery.
Sometimes it is careful observation.
The key is understanding which approach is most appropriate for you. Contact Compass Surgical to arrange a consultation.
Article 1 of 8 – What Are Gallstones and What Symptoms Do They Cause?
Article 2 of 8 – Do Gallstones Go Away Without Surgery?
Article 3 of 8 – What Is Biliary Dyskinesia?
Article 4 of 8 – What About Gallbladder Polyps?
Article 5 of 8 – What Is Laparoscopic Gallbladder Surgery?
Article 6 of 8 – What Are the Risks of Gallbladder Surgery?
Article 7 of 8 – Recovery After Gallbladder Surgery
Article 8 of 8 – Why Your Follow-Up Appointment Matters After Gallbladder Surgery?
Dr Thomas Hanna MBChB, FRCS, MSc, PGCE, PhD
Dr Thomas Hanna is a general and transplant surgeon practising in Auckland. He trained in the United Kingdom before moving to New Zealand in 2019. He has specialist interests in gallbladder surgery, hernia repair, minimally invasive surgery and complex abdominal surgery. Tom is a founding partner of Compass Surgical and is committed to patient-centred surgical care, clear communication and surgery performed with integrity.
Dr Peter Swan MBChB, FRACS
Dr Peter Swan is a general surgeon practising in Auckland with expertise in gallbladder surgery, hernia repair and general surgical conditions including lumps and bumps. He is a founding partner of Compass Surgical. Peter’s practice focuses on practical, evidence-based advice, careful patient selection and personalised treatment.
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