Of portal hepatic nodes, excision of the gall bladder bed, and right hepatic lobectomy at initial cholecystectomy, thus improving survival2 and reducing the costs of repeat operation. What remains controversial and undecided, however, is how to select those patients who should have early cholecystectomy from those who should have six monthly follow up ultrasound. Certainly, rapidly enlarging lesions or those with areas of gall bladder wall thickening should be removed, including benign lesions in women, especially those over 60,3 and in patients with gallstones, even asymptomatic ones. buy viagra canada 7 in the study by moriguchi et al the size of the polyps was not related to whether malignancy developed, extrapolating from the adenoma–carcinoma sequence in which gall bladder adenomas are premalignant lesions. cheap viagra online 6 indeed in moriguchi et al’s study it is interesting that the larger polyps were found in the younger age group. Clearly, logistic reasons dictate that not every patient with polyps should have an instant cholecystectomy if asymptomatic, and there does have to be a process of sifting and selection, but, in my view, this should err towards the side of more frequent surgery in the fit patient for the reasons discussed above. â  next section references ↵ koga a , yamauchi s , izumi y , hamanaka n (1985) ultrasonographic detection of early and curable carcinoma of the gallbladder. kamagra generic viagra uk Br j surg 72:728–730. buy generic viagra [crossref] [medline] ↵ bivins ba , meeker wr , weiss dl , griffen wo (1975) carcinoma in situ of the gallbladder: a dilemma. buy viagra uk no prescription South med j 68:297–300. [medline] [web of science] ↵ koga a , watanabe k , fukuyama t , takiuguchi s , nakayama f (1988) diagnosis and operative indications for polypoid lesions in the gallbladder. cheap viagra Arch surg 123:26–29. viagra or viagra cost [crossref] [medline] [web of science] ↵ bergdahl l (1980) gallbladder carcinoma first diagnosed at microscopic examination of gallbladders removed for presumed benign disease. viagra or viagra price Ann surg 191:20–22. buy cheap viagra Search google scholar ↵ sawyer kc (1970) the unrecognized significance of papillomas, polyps, and adenomas of the gallbladder. Am j surg 120:570–578. [medline] ↵ aldridge mc , bismuth h (1990) gallbladder. cheap viagra fast shipping overnight