Evidence-Based Current Surgical Practice: Calculous Gallbladder Disease

• Published in: Journal of gastrointestinal surgery Vol. 16; no. 11; pp. 2011 - 2025
• Main Authors: Duncan, Casey B., Riall, Taylor S.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.11.2012; Springer Nature B.V
• Subjects: Age Distribution; Algorithms; Bile ducts; Cholangiopancreatography, Endoscopic Retrograde; Cholangiopancreatography, Magnetic Resonance; Cholangitis; Cholangitis - diagnosis; Cholangitis - surgery; Cholecystectomy; Cholecystitis, Acute - diagnosis; Cholecystitis, Acute - epidemiology; Cholecystolithiasis - complications; Cholecystolithiasis - epidemiology; Comorbidity; Disease; Edema; Endoscopy; Endosonography; Evidence-Based Current Surgical Practice; Gallbladder; Gallbladder diseases; Gallbladder Diseases - diagnosis; Gallbladder Diseases - diagnostic imaging; Gallbladder Diseases - surgery; Gallstones; Gallstones - diagnosis; Gallstones - surgery; Gastroenterology; Humans; Laparoscopy; Magnetic Resonance Imaging; Medicine; Medicine & Public Health; Mortality; Natural Orifice Endoscopic Surgery; Nausea; Pain; Pancreatitis; Pancreatitis - epidemiology; Surgery; Tomography, X-Ray Computed; Ultrasonic imaging; Vomiting; Womens health; United States > US; Gallbladder; Evidence-based; Surgery; Biliary
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-012-2024-1

Background Gallbladder disease is common and, if managed incorrectly, can lead to high rates of morbidity, mortality, and extraneous costs. The most common complications of gallstones include biliary colic, acute cholecystitis, common bile duct stones, and gallstone pancreatitis. Ultrasound is the initial imaging modality of choice. Additional diagnostic and therapeutic studies including computed tomography, magnetic resonance imaging, magnetic resonance cholangiopancreatography, endoscopic ultrasound, and endoscopic retrograde cholangiopancreatography are not routinely required but may play a role in specific situations. Discussion Biliary colic and acute cholecystitis are best treated with early laparoscopic cholecystectomy. Patients with common bile duct stones should be managed with cholecystectomy, either after or concurrent with endoscopic or surgical relief of obstruction and clearance of stones from the bile duct. Mild gallstone pancreatitis should be treated with cholecystectomy during the initial hospitalization to prevent recurrence. Emerging techniques for cholecystectomy include single-incision laparoscopic surgery and natural orifice transluminal endoscopic surgery. Early results in highly selected patients demonstrate the safety of these techniques. The management of complications of the gallbladder should be timely and evidence-based, and choice of procedures, particularly for common bile duct stones, is largely influenced by facility and surgeon factors.