Symptomatic Gallbladder Stone Disease

  • Michael R. CoxEmail author


The key symptom of symptomatic gallbladder stone disease is biliary pain (Chap.  4). This is the dominant symptom upon which decisions about surgical intervention are usually made. Biliary pain is used as the main determining feature for laparoscopic cholecystectomy as patients with biliary pain proceeding to cholecystectomy have a much higher rate of symptom relief than patients with other non-specific symptoms but no biliary pain (Chap.  4) (Berger, Parmar, Mertens, Schmidt 2012).


  1. 1.
    Berger MY, Olde Hartman TC, Bohnen AG. Abdominal symptoms: do they disappear after cholecystectomy? Surg Endosc. 2003;17:1723–8.CrossRefGoogle Scholar
  2. 2.
    Parmar AD, Sheffield KM, Adhikari D, Pavee RA, Varcas GM, Tamrisa NP, et al. Pre-op gallstone: a prognostic normogram for the management of symptomatic cholelithiasis in older patients. Ann Surg. 2015;262:171–8.CrossRefGoogle Scholar
  3. 3.
    Schmidt M, Sondenaa K, Dumot JA, Rosenblatt S, Hausken T, Ramnefjell M, Njolstad G, Eide GE. Post-cholecystectomy symptoms were caused by persistence of a functional gut disorder. World J Gastroenterol. 2012;18:1365–72.CrossRefGoogle Scholar
  4. 4.
    Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol. 1989b;42:1989.CrossRefGoogle Scholar
  5. 5.
    Cao AM, Eslick GD, Cox MR. Early laparoscopic cholecystectomy is superior to delayed in acute cholecystitis: a meta-analysis of case controlled studies. Surg Endosc. 2016;30(3):1172–82.CrossRefGoogle Scholar
  6. 6.
    Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seena V. Early verses delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomised trial. Surg Endosc. 2004;18:1323–7.CrossRefGoogle Scholar
  7. 7.
    Lai PBS, Kwong KH, Leung KC. Randomised trial of early verses delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg. 1998;85:764–7.CrossRefGoogle Scholar
  8. 8.
    Lo C, Liu C, Fan S, ECS L, Wong J. Prospective randomised study of early verses late laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998;227:461–7.CrossRefGoogle Scholar
  9. 9.
    Cox MR, Gunn IF, Eastman MC, Hunt RF, Heinz AW. Open cholecystectomy: a control group for comparison with laparoscopic cholecystectomy. Aust N Z J Surg. 1992;62:795–801.CrossRefGoogle Scholar
  10. 10.
    Meyer KA, Capos NJ, Mittelpunkt AI. Personal experiences with 1,261 cases of acute and chronic cholecystitis. Surgery. 1967;61:661–8.Google Scholar
  11. 11.
    Ganey JB, Johnson PA, Prillman PE, McSwain GR. Cholecystectomy: Clinical experience with a large series. Am J Surg, 1986;151:352–7.CrossRefGoogle Scholar
  12. 12.
    Halldestam I, Enell EL, Kullman E, Borch K. Development of symptoms and complications in individuals with asymptomatic gallstones. Br J Surg. 2004;91:734–8.CrossRefGoogle Scholar
  13. 13.
    Portincasa P, Di Ciaula A, Wang HH, Moschetta A, Wang DQH. Medicinal treatments of cholesterol gallstones: old, current and new perspectives. Curr Med Chem. 2009;16:1531–42.CrossRefGoogle Scholar
  14. 14.
    Festi D, Reggiani MLB, Attili AF, Loria P, Pazzi P, Scaioli E, et al. Natural history of gallstone disease: expectant management of active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol. 2010;25:719–24.CrossRefGoogle Scholar
  15. 15.
    Schmidt M, Hausken T, Glambek I, Schleer C, Eide GE, Sondenaa ICA. 24 year follow up of patients with silent gallstones showed no long term risk of symptoms or adverse events leading to cholecystectomy. Scand J Gastroenterol. 2011a;46:949–54.CrossRefGoogle Scholar
  16. 16.
    Attili AF, De Sontis A, Capri R, Redice AM, Maselli S, Capocacia L, et al. The natural history of gallstones: the GREPCO experience. Hepatology. 1995;21:656–60.CrossRefGoogle Scholar
  17. 17.
    Gracie WA, Ransohoff DF. The natural history of silent gallstones: The innocent gallstone is not a myth. N Engl J Med. 1982;307:798–800.CrossRefGoogle Scholar
  18. 18.
    Friedman GD. The natural history of asymptomatic and symptomatic gallstones. Am J Surg. 1993;165:399–404.CrossRefGoogle Scholar
  19. 19.
    Schmidt M, Sondenaa K, Vetrhus M, Berhane T, Eide GE. Long-term follow-up of a randomized controlled trial of observation versus surgery for acute cholecystitis: non-operative management is an option in some patients. Scand J Gastroenterol. 2011b;46:1257–62.CrossRefGoogle Scholar
  20. 20.
    Brazzelli M, Cruickshank M, Kilonzo M, Ahmed I, Stewart F, McNamee P, Elders A, Frazer C, Avernell A, Ramsay C. Systematic review of the clinical and cost effectiveness of cholecystectomy verses observation/conservative management of uncomplicated symptomatic gallstones or cholecystitis. Surg Endosc. 2015;29:637–47.CrossRefGoogle Scholar
  21. 21.
    Vetrhus M, Soreide O, Solhagg JH, Nesvik I, Sunderar K. Symptomatic, non-complicated gallbladder stone disease: operation or observation? A randomised clinical study. Scand J Gastroenterol. 2002;37:834–9.CrossRefGoogle Scholar
  22. 22.
    Beckingham IJ. ABC of diseases of liver, pancreas and biliary system: gallstone disease. BMJ. 2001;322:91–4.CrossRefGoogle Scholar
  23. 23.
    Thistle JL, Cleary PA, Lachin JM, Tyor MP, Hersh T. The natural history of cholelithiasis: The National Cooperative Gallstone Study. Ann Intern Med. 1984;101:171–5.CrossRefGoogle Scholar
  24. 24.
    Internal Clinical Guidelines Team (UK). Gallstone disease: diagnosis and management of cholelithiasis, cholecystitis and choledocholithiasis. London: National Institute for Health and Care Excellence; 2014.Google Scholar
  25. 25.
    Bates T, Ebbs SR, Harrison M, A’Hern RP. Influence of cholecystectomy on symptoms. Br J Surg. 1991;78:964–7.CrossRefGoogle Scholar
  26. 26.
    Borly L, Anderson IB, Bardram L, Christensen E, Sehested A, Kehlet H, et al. Preoperative prediction model of outcome after cholecystectomy for symptomatic gallstones. Scand J Gastroenterol. 1999;34:1144–52.CrossRefGoogle Scholar
  27. 27.
    Gui GP, Cheruvu CV, West N, Sivaniah K, Fiennes AG. Is cholecystectomy effective treatment for symptomatic gallstones? Clinical outcome after long-term follow–up. Ann R Coll Surg Engl. 1998;80:25–32.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Jarvinen HJ, Hastbacky J. Early cholecystectomy for acute cholecystitis: a prospective randomised study. Ann Surg. 1975;191:501–5.CrossRefGoogle Scholar
  29. 29.
    McArthur P, Cushchieri A, Sells RA, Shields R. Controlled clinical trial comparing early with interval cholecystectomy for acute cholecystitis. Br J Surg. 1975;62:850–2.CrossRefGoogle Scholar
  30. 30.
    Norby S, Herlin P, Holmin T, Sjodahl R, Tagesson C. Early or delayed cholecystectomy in acute cholecystitis: a clinical trial. Br J Surg. 1984;70:163–5.CrossRefGoogle Scholar
  31. 31.
    Nottle PD. Percutaneous laparoscopic cholecystectomy: indications, contraindications and complications. Aust N Z J Surg. 1992;62:188–92.CrossRefGoogle Scholar
  32. 32.
    Graves HA, Ballinger JF, Anderson WJ. Appraisal of laparoscopic cholecystectomy. Ann Surg. 1991;213:655–64.CrossRefGoogle Scholar
  33. 33.
    Flowers JL, Bailey RW, Scovill WA, Zucker KA. The Baltimore experience with laparoscopic management of acute cholecystitis. Am J Surg. 1991;161:388–92.CrossRefGoogle Scholar
  34. 34.
    Larson GM, Vitale GS, Casey S, et al. Multi-practice analysis of laparoscopic cholecystectomy in 1,983 patients. Am J Surg. 1992;16:221–6.CrossRefGoogle Scholar
  35. 35.
    Dubois F, Icard P, Berthecot G, Leuard H. Coeioscopic cholecystectomy. Ann Surg. 1990;211:60–2.CrossRefGoogle Scholar
  36. 36.
    Cuschieri A, Cubois F, Mouiel J, Mouiel P, Becker H, Buess G, Treded M, Troidl H. The European experience with laparoscopic cholecystectomy. Am J Surg. 1991;161:385–7.CrossRefGoogle Scholar
  37. 37.
    Cameron IC, Chadwick C, Phillips J, Johnson AG. Management of acute cholecystitis in UK hospitals: time for a change. Postgrad Med J. 2004;80:292–4.CrossRefGoogle Scholar
  38. 38.
    Rattner DW, Ferguson C, Warshow AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993;217:233–6.CrossRefGoogle Scholar
  39. 39.
    Kum CK, Eyrasch E, Lefering R, Math D, Paul A, Neugebaur E, et al. Laparoscopic cholecystectomy for acute cholecystitis: is it safe? World J Surg. 1996;20:43–9.CrossRefGoogle Scholar
  40. 40.
    Cox MR, Wilson TG, Luck AJ, Deans PL, Padbury RTA, Toouli J. Laparoscopic cholecystectomy for acute inflammation of the gallbladder. Ann Surg. 1993;218:630–4.CrossRefGoogle Scholar
  41. 41.
    Miller RE, Kimmelstiel FM. Laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc. 1993;7:296–9.CrossRefGoogle Scholar
  42. 42.
    Wilson RG, Macintyre IMC, Nixon SJ, Saunders JH, Varma JS, King PM. Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis. BMJ. 1992;305:394–6.CrossRefGoogle Scholar
  43. 43.
    Garber SM, Korman J, Cosgrove JM, Cohen JR. Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc. 1997;11:347–50.CrossRefGoogle Scholar
  44. 44.
    Koo KP, Thirlby RC. Laparoscopic cholecystectomy in acute cholecystitis: What is the optimal timing for operation? Arch Surg. 1996;131:50–5.CrossRefGoogle Scholar
  45. 45.
    Pepingco L, Eslick GD, Cox MR. The acute surgical unit as a novel model of care for patients presenting with acute cholecystitis. Med J Aust. 2012;196:509–10.CrossRefGoogle Scholar
  46. 46.
    Cao AM, Eslick GD, Cox MR. Early cholecystectomy is superior to delayed cholecystectomy for acute cholecystitis: a meta-analysis. J Gastrointest Surg. 2015;19:848–57.CrossRefGoogle Scholar
  47. 47.
    Chandler CF, Lane JS, Ferguson P, Thompson JE, Ashley SW. Prospective evaluation of early verses delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Am Surg. 2000;69:986–00.Google Scholar
  48. 48.
    Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L. Management of acute cholecystitis in the laparoscopic era: results of a prospective randomised clinical trial. J Gastrointest Surg. 2003;7:642–5.CrossRefGoogle Scholar
  49. 49.
    Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, Mayumi T, Yushida M, Strasberg S, Pitt H, De Santibanes E, Belghiti J, Buchler MW, Gouma DJ, Fan ST, Hilwano JC, Lau J, Kim SW, Belli G, Windsor JA, Liau KH, Sachakul V. Surgical treatment of patients with acute cholecystitis: Tokyo guidelines. J Hepatobiliary Surg. 2007;14:91–7.CrossRefGoogle Scholar
  50. 50.
    Senapati PSP, Bhattarcharya D, Harinath G, Ammori BJ. A survey of the timing and approach to the surgical management of cholelithiasis in patients with acute biliary pancreatitis and acute cholecystitis in the UK. Ann R Coll Surg Engl. 2003;85:306–12.CrossRefGoogle Scholar
  51. 51.
    Strasberg SM. Biliary injury in laparoscopic surgery: part 2: changing the culture of cholecystectomy. J Am Coll Surg. 2005;201:604.CrossRefGoogle Scholar
  52. 52.
    Shea JA, Healey MJ, Berlin JA, Clarke JR, Malet PF, Staroscik RN, Schwrtz JS, Wiliams SV. Mortality and complications associated with laparoscopic cholecystectomy: a meta-analysis. Ann Surg. 1996;224:609–20.CrossRefGoogle Scholar
  53. 53.
    Gossage JC, Forshaw MJ. Prevalence and outcome of litigations claims in England after laparoscopic cholecystectomy. Int J Clin Pract. 2010;64:1832–5.CrossRefGoogle Scholar
  54. 54.
    Gigot JF, Etienne J, Aerts R, et al. The dramatic reality of biliary tract injury at laparoscopic cholecystectomy: an anonymous multicentre Belgian survey of 65 patients. Surg Endosc. 1997;1:1171–8.CrossRefGoogle Scholar
  55. 55.
    Fort JM, Aziroz F, Cassellas F, et al. Bowel habit after cholecystectomy: physiological changes and clinical implications. Gastroenterology. 1996;111:617–22.CrossRefGoogle Scholar
  56. 56.
    Bunting DM. Port site hernia following laparoscopic cholecystectomy. J Soc Laparoendosc Surg. 2010;14:490–7.CrossRefGoogle Scholar
  57. 57.
    Nassar AH, Ashkar KA, Rashed AA, Abdulmoneum MG. Laparoscopic cholecystectomy and the umbilicus. Br J Surg. 1997;84:630–3.CrossRefGoogle Scholar
  58. 58.
    Mayol J, Garciz-Aguilar J, Ortiz-Oshiro E, De-Diego Carmona JA, Fernandez-Repressa JA. Risks of minimal access approach for laparoscopic surgery: Multivariate analysis of morbidity related to umbilical port insertion. World J Surg. 1997;21:529–33.CrossRefGoogle Scholar
  59. 59.
    Tonouchi H, Ohmori Y, Kobayashi M, Kusonoki M. Trocar site hernia. Arch Surg. 2004;139:128–56.CrossRefGoogle Scholar
  60. 60.
    Rhodes M, Lennard TW. Satisfaction after cholecystectomy. Lancet. 1988;1:599.CrossRefGoogle Scholar
  61. 61.
    Ros E, Zambon D. Post cholecystectomy symptoms: A prospective study of gallstone patients before and 2 years after surgery. Gut. 1987;28:150–4.CrossRefGoogle Scholar
  62. 62.
    Bouchier IAD, Rhodes K, Brien MA. A study of symptomatic and silent gallstones. Scand J Gastroenterol. 1968;3:299–304.CrossRefGoogle Scholar
  63. 63.
    Ahn KS, Han H-S, Cho JY, Yoon Y-S, Kim C, Lee WW. Long term follow up of non-operated patients with symptomatic gallbladder stones: a retrospective study evaluating the role of hepatobiliary scanning. BMC Gastroenterol. 2015;15:136–41.CrossRefGoogle Scholar

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© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Nepean Clinical School University of SydneySydneyAustralia

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