Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'.

Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'. Research Abstract Details 

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Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'. Abstract Text:

R H Dowling,

This article reviews selected aspects of the non-surgical/minimally invasive treatments of gallbladder stones (GBS) and discusses briefly the residual role of these treatments in the era of laparoscopic cholecystectomy. In patients with specific, gallstone-related symptoms who wish to retain their 'functioning' gallbladders, there are at least six different management options. They range from rapid but invasive to slow but safe: i) the rotary lithotrite; ii) percutaneous cholecystolithotomy; iii) percutaneous transhepatic or iv) endoscopic retrograde cannulation of the gallbladder followed by instillation (manual or pump-assisted) of contact solvents; v) extracorporeal shock-wave lithotripsy + adjuvant bile acids and; vi) oral bile acids alone. The recommended investigation sequence is i) ultrasound (to diagnose the presence of GBS), followed by ii) oral cholecystography (to assess cystic duct patency, gallbladder anatomy and GBS size, number, lucency, buoyancy, and contour), and iii) regional computed tomography scanning of the gallbladder (to predict stone composition and dissolvability and to plan routes of access to the gallbladder). The decision-making steps are i) choice of some form of active treatment versus no treatment (other than observation); ii) in those with specific symptoms and a patent cystic duct who opt for active treatment, to choose between removing versus retaining the gallbladder; and iii) in those who wish to retain their 'functioning' gallbladder, to offer and select the most appropriate of the alternative options. In conclusion, despite the excellence of laparoscopic cholecystectomy, there remains a place for the non-surgical/minimally invasive approaches in a carefully selected minority of symptomatic GBS patients. Although GBS may recur in approximately 50% of patients, the recurrent stones are often asymptomatic, can be detected 'early' by follow-up ultrasound, and are easily treated. Ultimately, the aim of gallstone research must be to prevent not only recurrent but also primary GBS formation, which would obviate the need for both medical and surgical treatment.

Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'. Publishing Authors By Initials

RH Dowling,

For similar therapeutics: lithotripsy research abstracts see: therapeutics: lithotripsy research

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Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'. Journal Published:

PUBLICATION TYPE: Review

Journal: Scandinavian journal of gastroenterology. Suppleme

VOLUME: 192

Page Numbers: 67-76

Journal Abbreviation: Scand. J. Gastroenterol. Suppl

ISSN: 0085-5928

DAY: 13

MONTH: 02

YEAR: 1992

Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'. Information

Number of References: 84

LANGUAGE: eng

NlmUniqueID: 437034

Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'. Keywords Mesh Terms:

KEYWORDS: Lithotripsy

MESH TERMS: therapy

Chemical & Substance for Abstract: Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'. Information

Substance Name: Bile Acids and Salts

Registry Number: 0

Grant and Affiliation Information for Gallbladder stones--dissolve, blast, or extract? Laparoscopic cholecystectomy versus 'the rest'.

AFFILIATION: Gastroenterology Unit, UMDS of Guy's Hospital, London, England.

Country: NORWAY

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MEDLINETA: Scand J Gastroenterol Suppl

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