Brief Answer:
as explained in details.

Detailed Answer:
Hi.
Thanks for your query.
To recapitulate: Female/49 - 2 gal stones 18 and 13 mm - infection - advised to wait for 6 weeks - for the infection to settle - completed the course of medicines as you have mentioned - no improvements - still have pain, sometimes severe - wants to know whether there is any risk to operate immediately ....

I will try to simply the explanation:
When the gall bladder is acutely inflamed the following difficulties are encountered during surgery of an acute gall bladder:
- The gall bladder is edematous including the area near the place where we separate the tube/duct joining the main bile duct. Due to improper dissection there is a chance that the whole gall bladder can not be removed in too or there is a chance of injury to the common bile duct and main structures and this is a dreaded complication, which we should avoid at any cost.
Secondly, the surrounding structures like the hilum of liver with important ducts and blood vessels, duodenum, large intestine and stomach are sometimes stuck together and either impossible to separate or there is a chance of injury to these structures.
Once we give chance for inflammation to subside with proper medication, these adhesion, edema all subside making surgery easily done and the chances of complications is drastically reduced.
If the pain is still there, this means:
The antibiotic was not very effective hence another antibiotic is given for to be more effective.
Or there is severe inflammation and blockage to the ducts causing the pains.
There an be even pre-gangrenous changes.

Hence I would advise her the following in such a situation:
Change over to another antibiotic.
Continue anti-inflammatory medication.
Ultrasonography and color doppler of the area to see whether there is any improvement radiologically or not, any further complications as anticipated.
EUS that is endoscopic ultrasound if available will help to see the esophagus, stomach and duodenum, as well as get most beneficial information about gall bladder, liver, pancreas.

Such large stones usually remain in the gall bladder and do not pass into the bile ducts causing further complications. But the inflammation is so severe that it may lead to gangrene of the gall bladder with attendant complications.


Hence due to the anticipated complications the Surgeon thinks about conservative/ medical treatment so that a proper and more meaningful surgery can be done after 6 weeks with great results.
Immediate surgery can lead to incomplete surgery and/or injury to the important parts nearby; many times even not allowing to reach the site due to dense adhesions.

I hope, this answers your query. Please feel free to ask for further relevant queries if you feel that there is a gap of communication.

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