Expectant management of patients with gallbladder stones diagnosed at planned investigation. A prospective 5- to 7-year follow-up study of 153 patients. Postcholecystectomy symptoms. A prospective study of gall stone patients before and two years after surgery. The natural history of cholelithiasis: the National Cooperative Gallstone Study. A Randomized Controlled Study of Uncomplicated Gallstone Disease with a 14-Year Follow-Up Showed that Operation Was the Preferred Treatment Wait-and-see policy or laparoscopic cholecystectomy after endoscopic sphincterotomy for bile-duct stones: a randomised trial Pain and quality of life in patients with symptomatic, non‐complicated gallbladder stones: results of a randomized controlled trial Randomization to surgery or observation in patients with symptomatic gallbladder stone disease. The problem of evidence-based medicine in clinical practice. Long term response to gallstone treatment--problems and surprises. Is biliary pain exclusively related to gallbladder stones? A controlled prospective study. Pain persists in many patients five years after removal of the gallbladder: Observations from two randomized controlled trials of symptomatic, noncomplicated gallstone disease and acute cholecystitis Symptomatic, non-complicated gallbladder stone disease. Operation or observation? A randomized clinical study. Occult microlithiasis in 'idiopathic' acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Symptomatic and silent gall stones in the community. Ten-year incidence and natural history of gallstone disease in a rural population of women in central Italy. The Rome Group for the Epidemiology and Prevention of Cholelithiasis (GREPCO). Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: a cohort analysis. Acute cholecystitis: delayed surgery or observation. A randomized clinical trial. Laparoscopic Cholecystectomy for Acute Cholecystitis: Is It Really Safe?
BACKGROUND Few studies have been done on the expectant management of patients with cholelithiasis diagnosed by planned investigation , and results are conflicting . METHODS A prospect i ve 6-year follow-up study of 153 patients with cholelithiasis diagnosed by oral cholecystography  was carried out . RESULTS An acute gallstone complication occurred during the follow-up period in 23 patients (15%)-that is , acute cholecystitis ( n = 18 ) , acute pancreatitis ( n = 2 ) , and jaundice ( n = 3 ) . The annual risk of developing an acute biliary complication was 3.1 % . A history of a gallstone complication predicted further gallstone complications during follow-up . The overall cholecystectomy rate was 20 % during the 1st year but fell to about 3 % during the 5th year of follow-up . Young age and frequent attacks of biliary pain episodes predicted the need for gallstone surgery . CONCLUSIONS Expectant management of patients with electively diagnosed cholelithiasis may be justified , especially in those with only occasional biliary symptoms and no history of gallstone complications The results of cholecystectomy in terms of symptomatic improvement were prospect ively evaluated in 124 unselected gall stone patients interviewed before and two years after elective surgery . Indications for cholecystectomy were biliary pain ( n = 65 ) , previous complications of gall stone disease ( n = 52 ) , and flatulent dyspepsia ( n = 7 ) . At two years 93 patients could be re-evaluated , of whom only 49 ( 53 % ) were completely symptom free . Postcholecystectomy symptoms occurring in the remaining 44 patients were mainly flatulent dyspepsia ( which had relapsed in 22 of 46 patients who suffered it preoperatively ) , dull abdominal pain or diarrhoea . Incisional hernia was present in five patients and one had recurrence of pain because of retained common bile duct stones . Symptomatic cures after cholecystectomy decreased with the duration of the preoperative history . The results reconfirm that cholecystectomy  eradicates specific symptoms and complications of gall stone disease , but they also show that nearly one half of operated patients are dissatisfied with the procedure because of mild but distressing ' postcholecystectomy ' symptoms . These are probably caused by previously undiagnosed functional gut disease associated with , but unrelated to , gall stones . A systemic approach to multisymptomatic patients with gall stones is recommended The National Cooperative Gallstone Study , a double-masked , placebo-controlled , therapeutic trial of chenodiol ( chenodeoxycholic acid ) , provided an opportunity to study the natural history of cholelithiasis in patients who choose nonsurgical management . The major component of the study comprised 916 patients , 305 of whom were r and omly assigned to receive a placebo for 24 months . Among these 305 patients , the probability of having biliary tract pain during the 24 months of prospect i ve evaluation was significantly increased if the patient had had a history of biliary tract pain in the 12 months before entry into the study ( 69 % versus 31 % ) . Thirty-eight percent of patients had stone growth ( greater than 0.5 cm3 ) , and 18 % had a spontaneous decrease in stone volume . Despite the high incidence of biliary tract pain , nonelective cholecystectomy was required in only 4 % of patients during the 24 months Background / Aims : Cholecystectomy is considered the treatment of choice for symptomatic gallstone disease . Some patients abstain from surgery and provide the opportunity to study the natural history of cholelithiasis . The aim of the present study was to examine the feasibility and safety of observation after extended long-term follow-up in a r and omized controlled trial . Methods : A total of 137 patients ( 40.5 % of those assessed ) were r and omized to observation or cholecystectomy and followed up for 14 years . The prevalence of symptomatic events or major complications after treatment was the primary end point . A secondary end point was completion of r and omized treatment . Results : There were no differences in outcome between the observation group and the surgical group ( p = 0.298 ) . Virtually no  cholecystectomy  was performed after 5 years of follow-up , and no clear escalation in the severity of the disease was observed . A total of 50.7 % of patients from the observation group and 88.2 % from the surgical group underwent surgery . The group r and omized to surgery completed their design ated treatment significantly more often ( p < 0.001 ) , especially among patients younger than 70 years of age ( p = 0.005 ) . Conclusion : Cholecystectomy was the preferred treatment after extended long-term follow-up , but conservative management for symptomatic gallstone disease is an alternative to surgery in the elderly BACKGROUND Patients who undergo endoscopic sphincterotomy for common bile-duct stones , who have residual gallbladder stones , are referred for  laparoscopic cholecystectomy .  However , only 10 % of patients who do not have this operation are reported to develop recurrent biliary symptoms . We aim ed to assess whether a wait- and -see policy is justified . METHODS We did a prospect i ve , r and omised , multicentre trial in 120 patients ( age 18 - 80 years ) who underwent endoscopic sphincterotomy and stone extraction , with proven gallbladder stones . Patients were r and omly allocated to wait and see ( n=64 ) or laparoscopic cholecystectomy ( 56 ) . Primary outcome was recurrence of at least one biliary event during 2-year follow-up , and secondary outcomes were complications of cholecystectomy and quality of life . Analysis was by intention to treat . FINDINGS 12 patients were lost to follow-up immediately . Of 59 patients allocated to wait and see , 27 ( 47 % ) had recurrent biliary symptoms compared with one ( 2 % ) of 49 patients after laparoscopic cholecystectomy ( relative risk 22.42 , 95 % CI 3.16 - 159.14 , p<0.0001 ) . 22 ( 81 % ) of 27 patients underwent cholecystectomy , mainly for biliary pain ( n=13 ) or acute cholecystitis ( 7 ) . Conversion rate to open surgery was 55 % in patients allocated to wait and see who underwent cholecystectomy compared with 23 % in those who were allocated laparoscopic cholecystectomy ( p=0.0104 ) . Morbidity was 32 % versus 14 % ( p=0.1048 ) , and median hospital stay was 9 versus 7 days . Quality of life returned to normal within 3 months after either treatment policy . INTERPRETATION A wait- and -see policy after endoscopic sphincterotomy in combined cholecystodocholithiasis can not be recommended as st and ard treatment , since 47 % of expectantly managed patients developed at least one recurrent biliary event and 37 % needed cholecystectomy . No major biliary complications arose , but conversion rate was high Background : Cholecystectomy is intended to relieve symptoms of gallstones , but unfortunately some patients will experience postcholecystectomy symptoms , including pain . There is limited information in the literature on gallstone‐related pain and its influence on quality of life . The aim of this study was to examine how pain and quality of life in patients with symptomatic , uncomplicated gallbladder stones were affected by observation of their condition compared with removal of the gallbladder . Methods : One‐hundred and thirty‐seven patients were r and omized to observation ( watchful waiting ; n = 69 ) or cholecystectomy ( n = 68 ) and answered question naires on pain , quality of life ( PGWB index and NHP Part II ) at r and omization and fixed intervals ( 6 , 12 and 60 months ) . All gallstone‐related events ( hospital admission for pain , complications of gallstone disease and cholecystectomy ) and crossover between treatment groups were recorded . Results : Of patients r and omized to observation , 35 of 69 patients ( 51 % ) eventually underwent a cholecystectomy . Significant improvements in quality of life and pain scores were detected regardless of surgical treatment . Patients that subsequently experienced gallstone‐related events had significantly higher pain scores at r and omization than patients that did not experience any subsequent events , and this difference was maintained throughout follow‐up . Conclusions : Unexpectedly , in the majority of patients symptoms did abate without any significant differences between groups in pain and quality of life . Patients that had high intensity and frequency of pain at r and omization had a higher risk of experiencing subsequent events BACKGROUND The description and underst and ing of gallbladder stone disease in the medical literature are difficult because an assessment of the natural course of this symptomatic disease , with separation of patients in strictly defined groups , is generally lacking . METHOD A multicenter study was carried out with patients r and omized to either surgery or conservative , expectant treatment to examine optimal treatment and natural history in well-defined groups of symptomatic gallbladder stone disease with pain , episodes only ( study group 1 ) or acute cholecystitis ( study group 2 ) . The patients were between 18 and 80 years of age and had right upper quadrant or midline epigastric pain and ultrasonographic evidence of gallbladder stone , with or without acute cholecystitis . Medical treatment was ordinated on the basis of signs and symptom severity . Patients r and omized to surgery  were placed on the hospital 's waiting list and electively operated on with cholecystectomy as soon as conveniently possible . Preliminary results of follow-up are based on question naires mailed at regular intervals and consultations if required by the patients ' symptoms . Quality of life and freedom from pain are study end points for evaluation . RESULTS Five hundred and one patients were considered for the study , 318 patients ( 63.5 % ) belonging to group 1 and 183 ( 36.5 % ) to group 2 . One hundred and eighty-four patients ( 36.7 % ) were r and omized , 120 ( 24 % ) in group 1 and 64 ( 12.7 % ) in group 2 . Three hundred and seventeen patients ( 63.3 % ) , with an equal proportion from each study group , were excluded , the largest number of patients because of incapacitating pain or serious presenting symptoms ( 26 % ) . More women ( 81 % ) than men ( 19 % ) had pain alone ( group 1 ) , but the sex ratio was reduced , 56 % women and 44 % men , in patients with acute cholecystitis ( group 2 ) , with a highly significant difference ( P = < 0.001 ) between the two groups . A significant difference in patient withdrawal from r and omized treatment was registered , with 24 % from observation and 12 % from surgery ( P = 0.032 ) , but with an equal distribution in the two study groups . CONCLUSIONS A r and omized trial of this nature is feasible but extremely difficult to perform because of the heterogeneous nature of gallbladder stone disease , leading to exclusion of many patients and difficulties in measuring and evaluating outcome variables OBJECTIVE To re-evaluate after 5 years the results of a r and omised trial of cholecystectomy and lithotripsy for the treatment of symptomatic gallstones . DESIGN Late follow-up of a r and omised controlled trial . SETTING Teaching hospital , UK . SUBJECTS 144 of the 179 patients originally r and omised . INTERVENTIONS Either elective open cholecystectomy under general anaesthesia or a maximum of 4 sessions of lithotripsy ( up to 3000 shocks/session ) on consecutive days with no anaesthesia or analgesia . RESULTS Of the original 87 patients r and omised to be treated by lithotripsy , 39 ( 45 % ) subsequently underwent cholecystectomy , most of them within 32 months of treatment ( " crossover " group ) . Patients in both main groups had a pronounced reduction in the number of episodes of pain at 5 years and significant reductions in the mean severity scores both on VAS and the McGill rating . Those in the crossover group had the worst scores . Gastrointestinal symptoms improved in the two main groups , but again the crossover group did least well . Quality of life improved significantly over baseline in the two main groups , but was much poorer in the crossover group . CONCLUSIONS Patients who had primary cholecystectomy were more likely to be free of pain than those treated by lithotripsy . Lithotripsy gave good symptomatic results in 55 % of patients , and this was not dependent on clearance of stones . Patients who had a cholecystectomy after lithotripsy had the worst symptomatic results . It is difficult to identify patients who will not benefit from lithotripsy , but the presence of many coexisting symptoms may be an important predictor BACKGROUND The uncertainty around true clinical manifestations of gallbladder stone disease is in contrast with the unanimous recommendation that only symptomatic gallstones should be treated . AIM To evaluate the relationship between biliary pain , other gastrointestinal symptoms and gallstones . DESIGN OF STUDY A pragmatic , prospect i ve cohort question naire study . SETTING Seventy-five general practice s in Rotterdam , The Netherl and s. METHOD All patients suspected by their general practitioner ( GP ) to have gallstone disease underwent ultrasound examination of the upper abdomen .  Using a self-administered question naire , the presence of 11 gastrointestinal symptoms was assessed at inclusion and after 1 year . Likelihood ratios ( LRs ) for the presence of gallstones and symptom relief rates after 1 year were calculated . The mean difference in health status at inclusion and after follow-up was calculated for patients without gallstones , for patients with gallstones who were operated on and for patients with gallstones who were not operated on . RESULTS In total , 61 % of the patients with gallstones diagnosed by ultrasound scan reported biliary pain , as did 45 % of the patients without gallstones ( LR = 1.34 , 95 % confidence interval [ CI ] = 1.05 to 1.71 ) . Patients operated on for gallstone disease did not show significant relief of biliary pain compared to patients not operated on for gallstones or patients without gallstones ( 87 % , 63 % and 83 % , respectively ) . Health status improved in all patients . The mean improvement in health status did not differ between the three patient groups . GPs were able to discriminate between patients with high and low probability of gallbladder stones by ultrasound examination ( 53 % versus 23 % ) . This selection , however , did not predict the outcome of cholecystectomy . CONCLUSION Neither biliary pain nor any other gastrointestinal symptom was consistently related to gallstone disease . Therefore , the indication for elective cholecystectomy can not be based on the presence of biliary pain alone . Relief of biliary pain in patients operated on for gallstones should not simply be attributed to a successful cholecystectomy After removal of the gallbladder , pain may persist in some patients . To study this condition , 124 patients from two r and omized trials , including those with symptomatic noncomplicated gallbladder stones ( n = 90 ) and acute cholecystitis ( n = 34 ) , were interviewed , while 139 patients ( 90 % ) excluded from both trials responded to a question naire 5 years after the operation . Thirty-four patients ( 27 % ) of those r and omized had pain ; 23 ( 18 % ) had diffuse , steady pain ; and 11 ( 9 % ) had pain attacks resembling their preoperative symptoms . Asignificant dominance of diffuse pain occurred inwomen(P = 0.024 ) , especially those younger than 60 years ( P = 0.004 ) . A tendency for the diffuse type to be dominant was also present in the group of female patients with symptomatic noncomplicated gallbladder stones ( P = 0.052 ) . Of the excluded patients , 18 % ( 25/139 ) had pain , but 88 % of them ( 96 % of the men and 87 % of the women ) were satisfied with the result of the operation . The overall number of patients with postoperative pain was 22 % ( 59/263 ) . We conclude that persisting abdominal pain 5 years after the operation was mainly of a nonspecific type , found mostly in younger women who had had noncomplicated gallstone disease . Eightyeight percent of the excluded patients declared themselves satisfied with the result of cholecystectomy BACKGROUND Cholecystectomy has been recognized as the treatment of choice for symptomatic gallbladder stone disease . Not all patients are cured by an operation and the reason for having the gallbladder removed may rest on common practice rather than evidence -based medicine . The aim was to compare cholecystectomy with observation ( watchful waiting ) in patients with uncomplicated symptomatic GBS disease . Three-hundred- and -thirty-eight patients were considered for participation in the study ; 45 patients were excluded according to predefined criteria and 156 did not join for other reasons . The remaining 137 were r and omized to cholecystectomy ( n = 68 ) or non-operative , expectant treatment ( n = 69 ) . METHODS R and omized patients were contacted regularly and followed for a median of 67 months . All gallstone-related hospital contacts were registered in both r and omized and excluded patients . RESULTS Eight of the patients r and omized to cholecystectomy did not undergo operation , while 35 of the patients r and omized to observation later had their gallbladders removed . The cumulative risk of having a cholecystectomy seemed to level off after 4 years . Gallstone-related complications occurred in 3 patients in the observation group , 1 in the operation group and 5 of 201 excluded patients . After cholecystectomy , 16 of 222 patients had a major complication and 10 a minor . CONCLUSIONS We found that non-operative expectant treatment carries a low risk of complications . Patients should be informed that watchful waiting is a safe option Gallstone pancreatitis is usually related to small stones , which may not be detected by conventional cholecystographic techniques . In the current study , it was hypothesized that some patients with acute pancreatitis of unknown cause could harbor occult microstones in the gallbladder . Therefore , evidence was sought prospect ively of missed gallstones by biliary drainage and microscopic examination of centrifuged duodenal bile in 51 patients recovering from an attack of acute pancreatitis , including 24 patients with relapsing episodes . Clusters of cholesterol monohydrate crystals , calcium bilirubinate granules , and /or CaCO3 microspheroliths were found in 67 % of the patients . Biliary drainage showed no abnormal findings in 12 patients convalescing from a bout of known alcoholic pancreatitis . Examination of gallbladder bile at cholecystectomy and /or serial ultrasonography of the gallbladder for up to 12 months showed that 73 % of the patients with unexplained pancreatitis had biliary sludge or microlithiasis ; the prior finding of biliary crystal/solid markers predicted their existence with both a sensitivity and a specificity of 86 % and a predictive value of 94 % . The probability of harboring occult gallstones was also associated with age ( P = 0.004 ) , prior recurrent pancreatitis ( P = 0.024 ) , and altered liver function tests results during an index episode ( P = 0.003 ) . In 13 patients with cholesterol monohydrate crystals in bile , ursodeoxycholic acid ( 10 mg.kg-1.day-1 ) eliminated gallbladder microlithiasis within 3 - 6 months , and subsequent maintenance treatment with a daily dose of 300 mg prevented both gallstone recurrence and further attacks of pancreatitis over a mean follow-up period of 44 months . Cholecystectomy also prevented gallstone-associated relapses in 17 of 18 patients followed up for a mean postoperative period of 36 months . This study provides firm evidence showing that in most patients with idiopathic acute pancreatitis , the disease is related to microscopic gallstones , as evidence d by the follow-up development of macroscopic stones or sludge and by the prevention of relapses with either cholecystectomy or a cholelitholytic bile acid . Occult gallstones should be strongly suspected when acute pancreatitis of unknown cause occurs in a relapsing manner and in aged patients and when it is associated with altered liver function test results . Biliary microscopy and /or follow-up ultrasonography of the gallbladder provide a simple means of uncovering them to institute appropriate therapy and prevent further attacks The prevalence of gall stone disease in a stratified r and om sample of 1896 British adults ( 72.2 % of those approached ) was established using real time ultrasound . The prevalence rose with age , except in women of 40 - 49 years , so that at 60 - 69 years , 22.4 % of women and 11.5 % of men had gall stones or had undergone cholecystectomy . The  cholecystectomy rate of people with gall stone disease was higher in women than in men ( 43.5 % v 24 % , p less than 0.05 ) . Very few subjects with gall stones had convincing biliary symptoms . In women , 10.4 % had symptoms according to a question naire definition of biliary pain and 6.3 % according to conventional history taking , while no men at all admitted to biliary pain . Nevertheless , cholecystectomy in men had nearly always been preceded by convincing biliary symptoms . The age at cholecystectomy  was , on average , nine years less than the age at detection of silent gall stones in both sexes . It is concluded that either gall stones are especially prone to cause symptoms in younger people or that there are two kinds of cholelithiasis - symptomatic and silent . The lack of symptomatic gall stones in cross sectional surveys is probably due to their rapid diagnosis and treatment AIMS To investigate the incidence , risk factors and natural history of gallstone disease , a r and om sample of females belonging to a rural population was enrolled in a ten-year longitudinal study . METHODS The study has been performed in a small town on the hills south of Rome . In 1985 , a r and om sample of 426 females , aged 20 - 69 years , was screened by real-time ultrasonography for gallstones and previous cholecystectomy .  Screening methods included anthropometry , collection of a blood sample and a question naire on the occurrence of abdominal symptoms . During 1995 , all these subjects were invited for a 10-year follow-up examination . RESULTS The overall 10-year incidence of gallstone disease was 6.3 % ( 5.5 % of new gallstones and 0.8 % of cholecystectomies ) . Only 23.1 % of the women with gallstones were aware of their condition . More than three quarters ( 76.9 % ) had not suffered biliary pain . Univariate and multivariate analyses demonstrated a positive independent association of new gallstone disease with body mass index and parity . Out of the initially asymptomatic gallstone women , 15.4 % experienced at least one episode of biliary pain , 23.1 % were su bmi tted to elective cholecystectomy and 61.5 % remained asymptomatic . CONCLUSIONS The study demonstrates a high incidence of gallstone disease in women belonging to a rural free-living population in Italy and suggests body mass index and parity as possible true risk factors . Moreover , it confirms that a remarkable proportion of asymptomatic patients become symptomatic and eventually undergo cholecystectomy Whether ursodeoxycholic acid ( UDCA ) therapy alters the long-term clinical course of gallstones ( GS ) without stone dissolution remains unknown . We aim ed to clarify the relationship between long-term UDCA therapy and risks of biliary pain or acute cholecystitis in GS patients . We also aim ed to identify factors affecting the natural course , and to explore a simple patient selection criteria for UDCA therapy . A cohort of 527 uncomplicated GS patients with or without UDCA ( 600 mg/d ) followed for up to 18 years was analyzed . Patients who had frequent attacks or were complicated with cholecystitis were converted to cholecystectomy . History and UDCA therapy were identified on Cox analysis as 2 factors affecting the long-term clinical course . In patients without therapy , history was the only predictor of biliary pain among various patient or stone characteristics ; biliary pain was rare in asymptomatic patients , while frequent in symptomatic patients ( P < .001 ) . UDCA therapy was associated with reduced risk for biliary pain in both symptomatic ( 62 % vs. 92 % in untreated patients at 10 years ; P < .001 ; relative risk , 0.19 ; 95 % CI , 0.10 - 0.34 ) and asymptomatic patients ( 6 % vs. 12 % in untreated patients at 10 years ; P = .037 ; relative risk , 0.19 ; 95 % CI , 0.04 - 0.91 ) . Risk for the conversion was also reduced in UDCA-treated symptomatic patients ( 26 % vs. 88 % in untreated patients at 10 years , P < .001 ; relative risk , 0.08 ; 95 % CI , 0.03 - 0.22 ) . These effects were independent of stone dissolution . Three factors were identified on Cox analysis as affecting GS dissolution : radiolucency , small size ( < 10 mm ) of stones , and visualized gallbladder ( GB ) on cholecystogram . A selection criteria based on these appears to exhibit high sensitivity ( 74 % ) and specificity ( 95 % ) for dissolution . UDCA therapy might be considered in symptomatic patients fulfilling these criteria , and also in patients who have significant surgical risk , because the longterm therapy is clearly associated with reduced risk of biliary pain and acute cholecystitis BACKGROUND The aim of the present study was to compare the risk of observation versus that of cholecystectomy in acute cholecystitis in patients r and omly allocated to delayed operation or conservative treatment . METHODS One-hundred- and -eighty patients were considered for participation in the study ; 71 were excluded according to predefined criteria and 45 did not join for other reasons . The remaining 64 patients were r and omized to cholecystectomy ( n = 31 ) or observation ( n = 33 ) . R and omized patients were contacted regularly and followed up for a median of 67 months . All gallstone-related hospital contacts were registered in both r and omized and excluded patients . RESULTS Gallstone-related complications or emergency admissions for pain occurred in six patients in the operation group ( 19 % ; 95 % CI 5%-33 % ) and in 12 patients ( 36 % ; 9 % CI 20%-53 % ) in the observation group . Twenty-seven of 31 patients r and omized to cholecystectomy had a  cholecystectomy  at a median of 3.6 months after r and omization , and , of these , 3 ( 11 % ; 95 % CI 0%-23 % ) suffered a major and 7 ( 26 % ; 95 % CI 9%-42 % ) a minor complication . Ten patients r and omized to observation later had their gallbladders removed , 1 ( 10 % ; 95 % CI 0%-29 % ) patient had a major and 1 ( 10 % ; 95 % CI 0%-29 % ) a minor complication . We found no mortality after cholecystectomy . CONCLUSIONS We found a certain risk of subsequent gallstone-related events following conservative treatment of acute cholecystitis , but the data also show that cholecystectomy should not necessarily be compulsory after acute cholecystitis Abstract . The prospect ively collected data from 530 cholecystectomies performed in a university clinic from October 1989 to March 1991 were analyzed after 1 to 3 years of follow-up . The aim of this study was to compare the results of laparoscopic cholecystectomy ( LC ) for acute cholecystitis with that for routine symptomatic gallbladders . The preoperative , intraoperative , and postoperative parameters of 424 routine ( noninflamed ) LCs and 54 LCs for acutely inflamed gallbladders were compared under the “ intention to treat ” principle . Operating time was longer in the inflamed group ( median 97 minutes versus 75 minutes;p < 0.0001 ) . Significantly more adhesions ( 20 % versus 8 % ) , more blood loss ( 48 % versus 19 % ) , a higher incidence of bile spillage ( 28 % versus 12 % ) , and lost stones ( 19 % versus 8 % ) were encountered in patients with acute cholecystitis . Common bile duct ( CBD ) injuries were also more frequent in that group ( 5.5 % versus 0.2%;p = 0.005 ) . The rate of conversion to open surgery was higher than with routine LCs ( 13 % versus 4 % ) . There were two deaths in the routine LC group and none in the acutely inflamed group . There was no difference in postoperative pain intensity or postoperative fatigue according to visual analog scale measurements . Patients with acute cholecystitis stayed only 1 day longer ( median 4 days versus 3 days ) in hospital . The quality of life scores indicate return to almost normal values by the 14th postoperative day . Long-term follow-up ( 1–3 years ) did not reveal any delayed clinical adverse effects . In summary , LC for inflamed gallbladders has a higher conversion rate than LC for routine symptomatic gallbladders . If successfully performed , it has definite benefit for the patient in terms of better postoperative recovery . The trade-off is that the risk of CBD injury is significantly higher
The results of the economic evaluation suggest that , on average , the surgery strategy costs £ 1236 more per patient than the conservative management strategy but was , on average , more effective .
An increase in the number of people requiring surgery while treated conservatively corresponded to a reduction in the cost-effectiveness of the conservative strategy .
The results of this assessment indicate that cholecystectomy is still the treatment of choice for many symptomatic people .
However , approximately half of the people in the observation group did not require surgery or suffer complications in the long term indicating that a conservative therapeutic approach may represent a valid alternative to surgery in this group of people .
BACKGROUND Approximately 10 - 15 % of the adult population suffer from gallstone disease , cholelithiasis , with more women than men being affected .
Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones .
However , some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis .
As most of the current research focuses on the surgical management of the disease , less attention has been dedicated to the consequences of conservative management .
OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of  cholecystectomy  compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones ( biliary pain ) or cholecystitis .