[Choice and modalities of the treatment of biliary lithiasis]

Western life-style and an older population make gallstones, "silent" or otherwise, a commoner problem than in the past. Whilst symptomatic gallstones should be treated surgically, "silent" gallstones usually remain that way and do not require prophylactic cholecystectomy. However, if common bile duct stones have been demonstrated or only suspected, surgery is the treatment of choice even in the absence of symptoms. Surgical mortality is very low at less than 1% for cholecystectomy and bile duct exploration. These figures apply to a population of whom half are over 70 years of age. Chemical dissolution of cholesterol gallstones is only of use in a small minority of patients, notably those at high surgical risk or who refuse surgery. Endoscopic sphincterotomy is useful as primary treatment in cases of cholangitis and gallstone-associated pancreatitis, and often allows removal of bile duct stones in inoperable patients.