[Surgery of cholelithiasis: from past to present]

Area of Science:

• Gastroenterology and Hepatobiliary Surgery
• Surgical innovation in gallstone disease management

Context:

• Historical surgical interventions for cholelithiasis (gallstones) faced challenges with high complication and mortality rates.
• Pre-1980s surgical approaches for complicated gallstone disease, including acute cholecystitis, resulted in unsatisfactory outcomes, with postoperative lethality exceeding 37% for acute cholecystitis.
• The development of modern surgical techniques and understanding of gallstone disease pathogenesis was crucial for improving treatment efficacy.

Purpose:

• To review the evolution of surgical management for cholelithiasis (gallstone disease).
• To highlight the transition from traditional open surgeries to modern, less invasive techniques.
• To demonstrate the impact of these advancements on patient outcomes and mortality rates.

Summary:

• Early surgical treatments for gallstones, particularly complicated cases like acute cholecystitis, were associated with high mortality.
• The advent of improved surgical policies, minimally invasive procedures, and precision techniques marked a new era in cholelithiasis surgery.
• These modern approaches have led to a significant reduction in postoperative lethality, from over 37% to as low as 0.08-0.1%.

Impact:

• Substantial reduction in postoperative mortality for cholelithiasis patients.
• Improved safety and efficacy of surgical interventions for gallstone-related conditions.
• Establishment of current standards for surgical management of gallstone disease.