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Review
. 2022 Aug 16;109(9):832-838.
doi: 10.1093/bjs/znac154.

Tailoring diagnosis and treatment in symptomatic gallstone disease

Carmen S S Latenstein  1 , Philip R de Reuver  1
Affiliations
Review

Tailoring diagnosis and treatment in symptomatic gallstone disease

Carmen S S Latenstein et al. Br J Surg. .

Abstract

Background: There is a lack of consensus in selecting patients who do or do not benefit from surgery when patients present with abdominal pain and gallbladder stones are present. This review aimed to give an overview of results from recent trials and available literature to improve treatment decisions in patients with uncomplicated cholecystolithiasis.

Methods: First, an overview of different symptom criteria for laparoscopic cholecystectomy in patients with uncomplicated cholecystolithiasis is given, based on national and international guidelines. Second, treatment outcomes (absence of biliary colic, pain-free state, biliary and surgical complications) are summarized, with data from three clinical trials. Finally, personal advice for treatment decisions in patients with uncomplicated cholecystolithiasis is provided, based on recent trials, the available literature, and expert opinion.

Results: This review describes different guidelines and criteria sets for uncomplicated cholecystolithiasis, provides an overview of outcomes after cholecystectomy, and advises on treatment decisions in patients with abdominal pain and gallbladder stones. After cholecystectomy, biliary colic is resolved in 95 per cent of patients. However, non-specific abdominal pain persists in 40 per cent. Irritable bowel syndrome and functional dyspepsia significantly increase the risk of persistent pain. Age, previous abdominal surgery, baseline pain score on a visual analogue scale, pain characteristics, nausea, and heartburn are part of the SUCCESS criteria, and are associated with clinically relevant pain reduction after gallbladder removal.

Conclusion: The surgical community can now give more personalized advice on surgery to improve care for patients with abdominal pain and uncomplicated cholecystolithiasis.

Plain language summary

In primary care, more than 50 per cent of patients with ultrasonographically diagnosed gallbladder stones are diagnosed with concomitant abdominal disorders Laparoscopic cholecystectomy resolves biliary colic in 95 per cent of patients; however non-specific abdominal pain persists in up to 40 per cent Functional dyspepsia and irritable bowel syndrome significantly increase the risk of persistent pain after laparoscopic cholecystectomy Predictive factors for pain relief after cholecystectomy are older age, absence of previous surgery, pain characteristics, and absence of functional gastrointestinal disorders.

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Figures

Fig. 1
Fig. 1
Typical patient with gallbladder stones in primary care setting Registry data from 633 patients20. FGID, functional gastrointestinal disorder.
Fig. 2
Fig. 2
Patients with uncomplicated cholecystolithiasis at the surgical outpatient clinic Registry data based on the SECURE, PERFECT, and SUCCESS trials (total 1962 patients). IBS, irritable bowel syndrome.
Fig. 3
Fig. 3
Decision tree for patient with uncomplicated gallstone disease at the surgical outpatient clinic FGID, functional gastrointestinal disorder.
See this image and copyright information in PMC

References

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