From the Guidelines
Laparoscopic cholecystectomy is the recommended treatment for symptomatic cholelithiasis, as it is generally preferred and offers a reduced recovery time compared to open cholecystectomy, if a skilled surgeon is available. This procedure involves the surgical removal of the gallbladder, which eliminates the source of stone formation and prevents recurrent symptoms. According to the guidelines for the treatment of gallstones by the American College of Physicians 1, if the patient desires intervention, open cholecystectomy or laparoscopic cholecystectomy is generally preferred.
The potential problem of bile duct injury should be considered, especially for laparoscopic cholecystectomy 1. However, if the patient is attracted to the reduced recovery time associated with the laparoscopic treatment, then the clinician should determine if the surgeon is appropriately qualified and experienced in this new technology.
Some key points to consider in the management of symptomatic cholelithiasis include:
- Nonsurgical methods, such as oral bile acids, should be considered if the patient is a good candidate, with small stones (diameter less than 0.5 cm) that float during oral cholecystography 1.
- Lithotripsy may be considered for patients with a solitary radiolucent stone smaller than 2 cm, with adjuvant oral bile acids 1.
- Pain management during acute episodes includes NSAIDs like ketorolac or opioids if needed, and antispasmodics such as hyoscine butylbromide.
- Dietary modifications, including reduced fat intake and regular meals, can help manage symptoms while awaiting definitive treatment.
It is essential to note that surgery is recommended because gallstones typically recur when treated with non-surgical methods, and symptomatic stones often lead to complications like acute cholecystitis, pancreatitis, or biliary obstruction if left untreated. Therefore, laparoscopic cholecystectomy remains the preferred treatment option for symptomatic cholelithiasis, as it offers a definitive solution to the problem and reduces the risk of future complications 1.
From the FDA Drug Label
Ursodeoxycholic Acid (Ursodiol)
The recommended treatment for symptomatic cholelithiasis is not explicitly stated in the provided drug label.
- The label only mentions Ursodeoxycholic Acid (Ursodiol), but does not provide information on its use for symptomatic cholelithiasis treatment 2.
From the Research
Treatment Options for Symptomatic Cholelithiasis
- Laparoscopic cholecystectomy is considered the treatment of choice for patients with symptomatic cholelithiasis 3, 4, 5.
- The management of common bile duct stones remains controversial, with various surgical strategies available, including laparoscopic common bile duct exploration, sequential endoscopic and laparoscopic treatment, and combined endoscopic-laparoscopic treatment 3.
- Endoscopic sphincterotomy and endoscopic common bile duct clearance may be used in patients with choledocholithiasis, especially in those who are poor candidates for cholecystectomy 4.
- Cholecystectomy is indicated in patients with symptomatic cholelithiasis, especially those with non-functioning gallbladders 6.
Recommendations for Asymptomatic Cholelithiasis
- Asymptomatic cholelithiasis has a benign natural course, and the majority of patients do not require cholecystectomy 7.
- Selective cholecystectomy may be indicated in defined subgroups of patients with an increased risk for the development of gallstone-related symptoms and complications 7.
- Concomitant cholecystectomy may be a reasonable option for good-risk patients with asymptomatic cholelithiasis undergoing abdominal surgery for unrelated conditions 7.
Key Considerations
- The risk of the operation must be weighed against the risk of complications and death without operation, taking into account the symptomatic status of the individual and the functional status of the gallbladder 6.
- An in-depth knowledge of the natural history of gallstone disease is required to select the optimal management option for the individual patient with symptomatic or asymptomatic cholelithiasis 7.