Fortnightly review: Gallbladder disease

Gall stones are very common and their prevalence increases appreciably with age; it is also determined by sex, body weight, and race. Fortunately, most gall stones do not cause severe symptoms such as colic and jaundice. They are best detected by ultrasonography, although endoscopic retrograde cholangiopancreatography and magnetic resonance scanning may be required for duct stones. Troublesome gall stones are generally treated by cholecystectomy, and two thirds of these procedures are carried out by laparoscopy. Duct stones may be treated with endoscopic retrograde pancreatography, sphincterotomy, and extraction, or by open choledochotomy. Dissolution with ursodeoxycholic acid may be a useful reserve treatment for some patients. Persistent symptoms after surgery are common and are sometimes difficult to treat. Summary points Operations to remove gall stones have become more common, probably because indications for these have changed 70% of stones in the gall bladder do not cause symptoms Cholecystectomy relieves pain, but 50% of patients still have digestive symptoms afterwards Laparoscopic cholecystectomy has not reduced overall morbidity, mortality, or the cost of surgery because operations are now carried out in people who are older and less fit