D R Fletcher1. 1. University of Western Australia.
Abstract
BACKGROUND: Management of gallstones has changed as a result of new technologies, such as ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery. OBJECTIVE: This paper describes the clinical situations in which gallstones occur and their natural history. This is then related to the advantages and disadvantages of ERCP, laparoscopic cholecystectomy and open cholecystectomy. DISCUSSION: Laparoscopic cholecystectomy has become the treatment of choice, but does have risk of serious complications of which the patient should be informed. Incidental gallstones should generally be left untreated. Patients presenting with biliary pain are certain to develop recurrence and require elective cholecystectomy. Those with acute cholecystitis should be managed early, with laparoscopic or open operation depending on the experience of the surgeon. Patients with obstructive jaundice can undergo laparoscopic duct exploration or have an ERCP/sphincterotomy. Those with gallstone pancreatitis should have laparoscopic cholecystectomy within the same hospital admission.
BACKGROUND: Management of gallstones has changed as a result of new technologies, such as ultrasound, endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic surgery. OBJECTIVE: This paper describes the clinical situations in which gallstones occur and their natural history. This is then related to the advantages and disadvantages of ERCP, laparoscopic cholecystectomy and open cholecystectomy. DISCUSSION: Laparoscopic cholecystectomy has become the treatment of choice, but does have risk of serious complications of which the patient should be informed. Incidental gallstones should generally be left untreated. Patients presenting with biliary pain are certain to develop recurrence and require elective cholecystectomy. Those with acute cholecystitis should be managed early, with laparoscopic or open operation depending on the experience of the surgeon. Patients with obstructive jaundice can undergo laparoscopic duct exploration or have an ERCP/sphincterotomy. Those with gallstone pancreatitis should have laparoscopic cholecystectomy within the same hospital admission.