instruction: hello doctor I would like an opinion regarding surgery for acalculous biliary dyskinesia I have had run pain and colic attacks for the past three or four years ultrasounds at the time showed no symptoms then I had a hide scan that showed 12 ejection fraction so the doctor suggested surgery to remove the gallbladder even without stones or anything I declined I modified my diet the attacks became more sporadic but last month I had an acute acalculous cholecystitis event an ultrasound showed some sludge and my wall thickening again surgery was suggested and scheduled but symptoms resolved within a week and I am completely asymptomatic now I am really scared of having unnecessary surgery if I have no stones what is the worst that can happen if I just decline surgery I am afraid of having ongoing new indigestion symptoms post surgery I do not want new problems I am really afraid
output: hi since you had go sludge with multiple attacks of biliary colic the chances of getting a repeat attack are very high sludge or microlithiasis denote a dysfunctional gall bladder it is always better to remove a dysfunctional gall bladder as it has a high probability of stone formation all attacks need not be mild as you had at times severe attacks may happen which need emergency surgery there can be infectious episodes too the next severe complication happens from secondary pancreatitis this microlithiasis are not easily picked up on ultrasound scans so if you see the risks of retaining gallbladder and the advantages of surgery the advantages overweight the risks I would definitely recommend a planned surgery before developing complications and ending up with an infection and unplanned surgery I hope this helps