[Surgical treatment of cholelithiasis]

The indication for cholecystectomy has undergone a distinct change over the last few years due to the development of endoscopic and medical forms of therapy. The incidence of silent gallstones discovered incidentally has greatly increased owing to the widespread use of ultrasound. While surgery is not indicated in these cases, it is mandatory in acute and chronic septic complications, obstruction of the cystic duct or non-functional gallbladder. In a small number of patients, cholecystolithiasis can be treated with ESWL and chemolitholysis, but most will need surgery. Cholecystectomy is the sole causal therapy. Except in young patients, common bile duct stones are the domain of endoscopic papillotomy, even when the gallbladder is left in situ temporarily or (in high-risk patients) permanently. Here, endoscopy supplements the therapeutic concept even in emergency cases; stone extraction can obviate the need for common bile duct revision. Morbidity and mortality of gallstone surgery increase appreciably with patient age. Early operation is recommended in acute cholecystitis because of the lower morbidity and mortality rates. Present possibilities of individualized therapy require good interdisciplinary cooperation to prevent serious complications.