PubMed · 13670360
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G F MADDING. 1959. The macroscopically non-pathologic gallbladder.. https://doi.org/10.1016/0002-9610(59)90076-5
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Many patients with gallstones can be managed expectantly. Generally, only persons with symptoms related to the presence of gallstones (e.g., steady, nonparoxysmal pain lasting four to six hours located in the upper abdomen) or complications (such as acute cholecystitis or gallstone pancreatitis) warrant surgical intervention. Biliary pain is alleviated by cholecystectomy in the majority of cases. Laparoscopic cholecystectomy is considered the most cost-effective management strategy in the treatment of symptomatic gallstones. Medical management strategies are mostly palliative and are not widely supported. Patients with longer-lasting biliary pain, in combination with abdominal tenderness, fever, and/or leukocytosis, require an ultrasound evaluation to help establish a diagnosis of acute cholecystitis. Once a patient is diagnosed, having cholecystectomy early in the course of the disease can significantly reduce the hospital stay.
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Watchful waiting is the most important alternative to cholecystectomy in patients with uncomplicated gallstone disease. Symptom relief occurs in a large percentage of the patients, and the risk of developing complications is relatively small. However, in patients with a long life expectancy the cumulative risk may be significant, which must be taken into consideration. Extracorporal shock wave lithotripsy and medical treatment play a very small role in the treatment, and only on very special indications. The results of these methods are relatively poor and associated with a high recurrence rate.