[Treatment of cholecystolithiasis from the internal medicine viewpoint]

Abstract

There is no better treatment method for the cholecystolithiasis accompanied by symptoms than the cholecystectomy. In the so-called mute gall an expecting attitude is justified. During the last years for selected patients with gallstones and calculi in the common bile duct, respectively, non-surgical therapeutic methods were developed. So it is possible for carriers of gallstones with slight to moderate complaints to undergo a medicamentous trial of litholysis with chenodesoxycholic acid or ursodesoxycholic acid or above all with a combination of these two bile acids. X-ray-negative calculi of less than 1.5 cm with a functioning gallbladder are the prerequisite. The extracorporeal stoss-wave lithotripsy is a new interesting method as well as the percutaneous or retrograde instillation of methyl-butyl ether. In these cases we are at the beginning, the international development should be pursued with attention. In calculi of the bile duct apart from operative methods the papillotomy and the extraction of calculi more than stood the test. The stoss-wave lithotripsy in calculi of the bile duct, which are to be removed neither by instillation of solvents nor endoscopically is a way out of the difficulty in contrast to the operation. As it is evident from the demonstrated facts the cholecystectomy, as the Swiss surgeon Rewbridge remarked already over 50 years ago, is really not the last answer to the problems of the cholelithiasis. Today it is the point to use the method best suited for the patient.