[Current surgical and non-surgical possibilities in the treatment of gallbladder stones]

Abstract

For the treatment of gallstones in patients with normal stonefree bile ducts, new modalities have been developed besides the classical cholecystectomy and the oral litholysis. The interventional procedures (local litholysis, extracorporeal shockwave lithotripsy, combination of shockwave lithotripsy and local litholysis, cholecystostomy and extra- or intracorporeal lithotripsy) do not need a narcosis and can be applied even in high-risk patients. Because the gallbladder itself is not removed, the recurrence rate after all these interventions is rather high. The new operative procedures (laparoscopic cholecystectomy, mini-laparotomy cholecystectomy) are definitive solutions for stone disease, but must be performed mostly in narcosis. In order to determine for every patient the best and most appropriate treatment for his cholelithiasis, the number, the size and the composition of the stones must be known, and the gallbladder function and the bile ducts must be studied.