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Long term response to gallstone treatment--problems and surprises
1University Department of Surgical and Anaesthetic Sciences, University of Sheffield, United Kingdom.
The European Journal of Surgery = Acta Chirurgica
|July 13, 2000
Summary
Cholecystectomy offers better pain relief for symptomatic gallstones than lithotripsy over five years. Patients needing cholecystectomy after lithotripsy experienced the worst outcomes.
Area of Science:
- Gastroenterology
- Surgical Innovation
- Minimally Invasive Procedures
Background:
- Symptomatic gallstones pose a significant clinical challenge.
- Cholecystectomy and lithotripsy are established treatment options.
- Long-term comparative effectiveness data are crucial for clinical decision-making.
Purpose of the Study:
- To conduct a 5-year follow-up evaluation of a randomized trial comparing cholecystectomy and lithotripsy for symptomatic gallstones.
- To assess long-term outcomes, including pain, gastrointestinal symptoms, and quality of life.
Main Methods:
- A randomized controlled trial involving 144 patients.
- Interventions included elective open cholecystectomy or up to four sessions of lithotripsy.
- Late follow-up assessed outcomes at 5 years post-treatment.
Main Results:
- Primary cholecystectomy resulted in superior pain relief compared to lithotripsy at 5 years.
- Lithotripsy alone provided good symptomatic relief in 55% of patients.
- Patients undergoing cholecystectomy after initial lithotripsy (crossover group) reported the poorest outcomes.
Conclusions:
- Elective cholecystectomy is more effective than lithotripsy for achieving long-term pain freedom in symptomatic gallstone patients.
- Lithotripsy can be effective, but identifying non-responders, potentially indicated by coexisting symptoms, remains challenging.
- A staged approach involving lithotripsy followed by cholecystectomy yields suboptimal results.