The Natural History of Silent Gallstones

Gracie, William A.; Ransohoff, David F.

doi:10.1056/nejm198209233071305

Cited by 537 publications

(67 citation statements)

References 13 publications

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“…The probability that silent gallbladder stones become symptomatic within 1–2 decades has been reported to be 10 and 18–30%, respectively [17, 30, 31, 38, 39, 40]. The incidence of acute cholecystitis in patients with verified gallstone disease without previous ES has been reported as 7–10% [17, 18, 19], and even incidences as high as 15–20% [31]has been published.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ

et al. 2004

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Background: Obstructive jaundice caused by stones is a common disorder, mostly managed by endoscopic sphincterotomy followed by cholecystectomy. The aim of this study was to evaluate whether or not clearance of the common bile duct alone is sufficient as treatment for patients with choledocholithiasis. Methods: A cohort with 447 patients with symptomatic cholecystocholedocholithiasis, undergoing endoscopic retrograde cholangiography (ERC) and if necessary sphincterotomy (ES). In 164 patients common bile duct stones were proven and treated endoscopically, without performing a subsequent cholecystectomy. All 164 patients were free of symptoms after the endoscopic intervention. This group of patients was compared with 78 patients who underwent cholecystectomy after endoscopic treatment of common bile duct stones. Patients were followed for 1–13 years after ERC and sphincterotomy results and complications were registered. Results: The ages of the 164 patients in the in situ group were significantly higher than in the cholecystectomy group and the ASA classification (American Society of Anesthesiologists) was significantly higher in the in situ patients. Mean follow-up was 70.9 months. Of the in situ patients 27 (16%) returned with biliary symptoms; 12 with common bile duct stones, three with cholangitis, and one with stenosis of Vater’s papilla. Eight patients returned with cholecystitis and 3 with symptomatic cholecystolithiasis. Thirteen patients underwent cholecystectomy and 11 were managed (also) endoscopically. Minor complications were 2 wound infections and 1 bleeding after cholecystectomy. Two patients (1%) died of abdominal sepsis due to cholecystitis. Of the patients who underwent cholecystectomy, 6 (7.6%) returned during follow-up. Three patients had common bile duct stones, 2 had cholangitis and 1 patient presented with papillostenosis. Three patients needed surgical common bile duct exploration and the other 3 were treated endoscopically. After reintervention, cardiopulmonary complications were observed in 1 patient. There was no related death. Conclusion: When common bile duct stones are treated successfully by endoscopic sphincterotomy and patients are free of symptoms, there is no need for routine prophylactic cholecystectomy.

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Section: Discussionmentioning

confidence: 99%

Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ

et al. 2004

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“…Authors who recommend expectant management for patients with asymptomatic gallstones suggest that prophylactic cholecystectomy has a higher mortality rate than watchful waiting [4, 7, 8]. However, for this analysis some of these authors consider the mortality rate of cholecystectomy performed to treat patients of all ages with symptomatic gallstones, including those with complications such as gallbladder empyema and acute pancreatitis [3, 4].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Cholecystectomy to Treat Patients with Asymptomatic Gallstones

Coelho¹,

Junior²,

Salvalaggio³

et al. 2000

Dig Surg

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Background/Aims: The management of patients with silent or asymptomatic gallstones remains controversial. The objective of this study is to determine the complications of laparoscopic cholecystectomy performed to treat patients under 50 years of age with asymptomatic gallstones. Method: 207 patients, 13–49 years of age with asymptomatic gallstones, were subjected to laparoscopic cholecystectomy. There were 161 (78%) women and 46 (22%) men. Results: Operative time varied from 25 to 95 min, with an average of 42 min. The length of hospitalization varied from 12 h to 2 days. In no patient was the operation converted to laparotomy. There was neither mortality nor major complications. The following minor complications were observed: vomiting in 43 patients (20.7%), fever in 16 (7.7%), minor skin infection in 7 (3.3%), and keloid in 2 (0.9%). Conclusion: It is concluded from this study that laparoscopic cholecystectomy is a safe procedure in the treatment of patients under 50 years of age with asymptomatic gallstones.

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“…Biliary colic is one of the common initial presentations of gallstone-related problems [3, 8]. Impaction of a stone in the neck of the gallbladder or in the cystic duct is thought to result in spasm which causes visceral pain.…”

Section: Introductionmentioning

confidence: 99%

Urgent Laparoscopic Cholecystectomy Is the Best Management for Biliary Colic

Salman

Yüksel²,

İrkörücü³

et al. 2005

Dig Surg

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Background/Aim: Delay of laparoscopic cholecystectomy after the diagnosis of biliary colic may increase the probability of recurrent emergency admission while awaiting elective cholecystectomy. The aim of this study was to compare the possible advantages and safety of urgent laparoscopic cholecystectomy (ULC) with elective laparoscopic cholecystectomy (ELC) in patients with biliary colic. Patients and Methods: Between 2001 and 2003, 75 patients with biliary colic were included in this study. The patients were classified into following two groups: patients who had ULC in 24 h were in group I (n = 28) and patients who had ELC (mean interval 4.22 ± 1.42 months) were in group II (n = 35). Conversion to open cholecystectomy, operative time, postoperative hospital stay, costs, and complications were evaluated. Results: In group II, 9 patients made a total of 13 return visits to the emergency department with recurrent attacks of biliary colic or complications of gallstone disease. Mean operative time increased from 35.1 ± 6.74 min for urgent laparascopic cholecystectomy to 49.9 ± 6.12 min for ELC (p > 0.05) and hospital stay time increased from 1.06 ± 0.4 to 2.31 ± 2.36 days (p < 0.05). Conversion to open cholecystectomy increased from 0% in group I to 17.2% in group II (p < 0.05). Discussion: ULC for biliary colic may be the most medically efficacious and cost-effective treatment.

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The Natural History of Silent Gallstones

Cited by 537 publications

References 13 publications

Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ

Endoscopic Management of Common Bile Duct Stones Leaving the Gallbladder in situ

Laparoscopic Cholecystectomy to Treat Patients with Asymptomatic Gallstones

Urgent Laparoscopic Cholecystectomy Is the Best Management for Biliary Colic

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