[Symptomatic cholecystolithiasis: 1992 therapy options]

Modern treatment of symptomatic cholecystolithiasis requires a knowledge of several nonsurgical and surgical treatment options. Extracorporeal shock-wave lithotripsy and oral bile acid therapy offer the possibilities of noninvasive, outpatient treatment in approximately 20% of all symptomatic gallstone patients at a low complication rate. The percutaneous interventional techniques such as contact dissolution by means of ether or mechanical stone removal may in principle be used in a higher percentage of patients but are considerably more invasive. None of the nonsurgical techniques can exclude the relative risk of gallstone recurrence. Laparoscopic cholecystectomy constitutes a major progress in the surgical treatment of gallstone disease, since it is much less invasive than conventional cholecystectomy and requires a much shorter hospital stay and recovery time. The laparoscopic technique is primarily indicated in patients with symptomatic, uncomplicated cholecystolithiasis. Nevertheless, the range of indications is expanding as experience with this technique increases. Under certain circumstances, laparoscopic cholecystectomy is already being combined with endoscopic sphincterotomy in the presence of bile duct calculi. Conventional cholecystectomy remains the treatment of choice for complicated cases.