From the Guidelines
Gallstone management depends on whether the stones are symptomatic or asymptomatic, with asymptomatic gallstones generally requiring no treatment and symptomatic gallstones often necessitating laparoscopic cholecystectomy. For asymptomatic gallstones, expectant management is recommended due to the low risk of complications and the benign natural history of the disease 1. However, patients with a high risk for gallbladder cancer, such as those with calcified gallbladders or large stones, may be exceptions to this recommendation 1.
For symptomatic gallstones, the choice of treatment is more complicated. The clinician should determine if the biliary pain is the first episode and whether the pain indicates gallstone disease, and assess the patient's treatment goals and attitudes 1. If the patient desires intervention, open cholecystectomy or laparoscopic cholecystectomy is generally preferred, with the latter offering a shorter recovery time but also carrying a risk of bile duct injury 1. Nonsurgical methods, such as oral bile acids or extracorporeal shock wave lithotripsy, may be considered for patients who are poor surgical candidates or have specific stone characteristics 1.
Key considerations in gallstone management include:
- Asymptomatic gallstones: expectant management
- Symptomatic gallstones: laparoscopic cholecystectomy or alternative treatments for poor surgical candidates
- High-risk patients: consideration of prophylactic cholecystectomy
- Patient education: discussion of treatment goals, risks, and benefits
Overall, the management of gallstones should be individualized based on patient characteristics, stone characteristics, and treatment goals, with a focus on preventing complications and improving quality of life 1.
From the Research
Gallstone Management Options
- Laparoscopic cholecystectomy is a minimally invasive procedure for removing the gallbladder, suitable for patients with symptomatic gallstones or biliary dyskinesis 2
- Indications for cholecystectomy are limited to clearly symptomatic gallstones, with contraindications related to anaesthesiological considerations 3
- Cholecystectomy remains the "gold standard" for managing symptomatic gallstones, with minimally invasive laparoscopic cholecystectomy being the treatment of choice for the past 3 decades 4
Alternative Treatment Approaches
- Natural orifice transluminal endoscopic surgery cholecystolithotomy is an evolving technique for gallbladder stone removal without gallbladder excision, aiming to preserve gallbladder function and eliminate post-cholecystectomy syndromes 4
- Extracorporeal shock-wave lithotripsy with ursodiol is a treatment option for symptomatic gallstones, with ursodiol administration increasing the efficacy and safety of the procedure 5
Considerations for Treatment Selection
- Patient selection is crucial, with relatively high failure rates of pain relief likely caused by incorrect selection of patients for cholecystectomy 3
- The role of alternative medical and surgical treatments for gallstones should be considered, including the comparative results of laparoscopic cholecystectomy with open cholecystectomy and other available treatments 6
- Techniques for detecting and treating bile duct stones with or without laparoscopic cholecystectomy should be taken into account 6