Fortnightly Review: The treatment of gall stones

Tait, Noel; Little, J. M.

doi:10.1136/bmj.311.6997.99

Cited by 42 publications

(22 citation statements)

References 58 publications

(51 reference statements)

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“…In 1992, it was estimated that 10-15% of the adult population in the USA had gallstones (which amounted to more than 20 million people), with women suffering twice as much as men [4,5,[8][9][10]. About one million patients are newly diagnosed annually (10) and among them 50-70% are asymptomatic at diagnosis (6,8).…”

Section: Asymptomatic Cholelithiasis: the Extent Of The Problemmentioning

confidence: 99%

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Asymptomatic Cholelithiasis: Is Cholecystectomy Really Needed? A Critical Reappraisal 15 Years After the Introduction of Laparoscopic Cholecystectomy

Sakorafas¹,

Milingos²,

Peros³

2007

Dig Dis Sci

198

129

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Asymptomatic cholelithiasis is increasingly diagnosed today, mainly as a result of the widespread use of abdominal ultrasonography for the evaluation of patients for unrelated or vague abdominal complaints. About 10-20% of people in most western countries have gallstones, and among them 50-70% are asymptomatic at the time of diagnosis. Asymptomatic gallstone disease has a benign natural course; the progression of asymptomatic to symptomatic disease is relatively low, ranging from 10-25%. The majority of patients rarely develop gallstone-related complications without first having at least one episode of biliary pain ("colic"). In the prelaparoscopy era, (open) cholecystectomy was generally performed for symptomatic disease. The minimally invasive laparoscopic cholecystectomy refueled the discussion about the optimal management of asymptomatic cholelithiasis. Despite some controversy, most authors agree that the vast majority of subjects should be managed by observation alone (expectant management). Selective cholecystectomy is indicated in defined subgroups of subjects, with an increased risk for the development of gallstone-related symptoms and complications. Concomitant cholecystectomy is a reasonable option for good-risk patients with asymptomatic cholelithiasis undergoing abdominal surgery for unrelated conditions. Routine cholecystectomy for all subjects with silent gallstones is a too aggressive management option, not indicated for most subjects with asymptomatic cholelithiasis. An in-depth knowledge of the natural history of gallstone disease is required to select the optimal management option for the individual subject with silent gallstones. Management options should be extensively discussed with the patient; he or she should be actively involved in the process of therapeutic decision making.

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Section: Asymptomatic Cholelithiasis: the Extent Of The Problemmentioning

confidence: 99%

“…About one million patients are newly diagnosed annually (10) and among them 50-70% are asymptomatic at diagnosis (6,8). Approximately 600,000 patients underwent cholecystectomy in 1991 in the USA [11] and about 4-7% of those operated had asymptomatic cholelithiasis [12].…”

Section: Asymptomatic Cholelithiasis: the Extent Of The Problemmentioning

confidence: 99%

Asymptomatic Cholelithiasis: Is Cholecystectomy Really Needed? A Critical Reappraisal 15 Years After the Introduction of Laparoscopic Cholecystectomy

Sakorafas¹,

Milingos²,

Peros³

2007

Dig Dis Sci

198

129

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“…In U/S the gall-bladder is a pear shaped anechoic structure, smooth wall in the inferior aspect of the right lobe of the liver [3] , anomalies ofthe gallbladder are generally of minimal clinical significance [4] . Gallbladder and the duct draining the gallbladder take the course of normal common bile duct to the duodenum [5] . All the hepatic cells continually for a small amount of secretion called bile [6] .…”

Section: Imentioning

confidence: 99%

Diagnosis ofacute cholecystitis using ultrasonography

Gameraddin¹,

Salih²,

Suliman³

2013

IOSR-JDMS

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“…Gallengangssteine können primär in den Gallengängen entstehen oder sekundär aus der Gallenblase in den Ductus hepatocholedochus einwandern. Der Choledocholithiasis wird ein hohes Komplikationspotential zugeschrieben, weshalb sie unabhängig vom Vorhandensein von Symptomen in der Regel als behandlungsbedürftig gilt [8]. Etwa die Hälfte der Gallengangssteine bleibt asymptomatisch.…”

Section: Introductionunclassified

Interdisziplinäre Sonographie bei akutem Abdomen – gastroenterologische Perspektive

Schacherer¹,

Schlottmann²

2006

Visc Med

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The acute abdomen represents an emergency condition which requires urgent diagnosis and therapy. Sonography plays an important role as a fast, effective and efficient imaging modality. Most causes of the acute abdomen can be diagnosed with ultrasound, however, ultrasound has its domain in the diagnosis of biliary tract disorders and in evaluating abdominal tumors. Beside B-mode sonography, contrast-enhanced ultrasound is increasingly used to diagnose organ infarction. Sensitivity as well as specificity in the diagnosis of acute appendicitis are high, and sonography may play an important role in describing sigma diverticulitis. Although the pancreas is often invisible due to gas, newer studies describe the use of contrast-enhanced sonography in this context. Intraabdominal fluid can be punctured sonographically, and cysts, abscesses and exsudates may be cured with drainages. Sonographically guided biopsy helps in the diagnosis of suspect solid lesion in the abdomen. Sonography may diagnose the most common causes of acute abdomen. However, the multifactorial etiology of this condition represents a challenge, and interdisciplinary cooperation is essential.

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Fortnightly Review: The treatment of gall stones

Cited by 42 publications

References 58 publications

Asymptomatic Cholelithiasis: Is Cholecystectomy Really Needed? A Critical Reappraisal 15 Years After the Introduction of Laparoscopic Cholecystectomy

Asymptomatic Cholelithiasis: Is Cholecystectomy Really Needed? A Critical Reappraisal 15 Years After the Introduction of Laparoscopic Cholecystectomy

Diagnosis ofacute cholecystitis using ultrasonography

Interdisziplinäre Sonographie bei akutem Abdomen – gastroenterologische Perspektive

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