Gallstone disease natural history, complications and prognosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

A study was conducted on a cross-section of middle income Americans to examine the natural history of gallstones.
The study had a total of 691 patients.
Of the 691 patients, 556 (80.5%) patients exhibited symptoms attributable to gallbladder disease and the other 135 (9.5%) patients were asymptomatic.
In the symptomatic group, 242 (44%) eventually underwent a cholecystectomy in order to relieve their persistent symptoms.
Only 10% of the asymptomatic group developed symptoms of gallstones, and 7% required a cholecystectomy.
In total, there were 50 deaths in this series of 691 patients, 25 in the symptomatic group and 25 in the asymptomatic.
Only 2 of these deaths were related to gallstone disease. This study therefore concluded that silent (asymptomatic) stones do not need to operated on until symptoms develop. *The study also found that patients usually tolerated their symptoms for very long periods of time and would not readily undergo surgery.^[1]

Around 45% of patients with gallstone disease will develop symptoms.
Patients who refuse surgery or are unfit to undergo surgery will remain asymptomatic or experience varying degrees of complications in 45% and 55% of the time respectively.
Elective cholecystectomy has 0.5% and 10% respectively.
Emergent cholecystectomy has a mortality rate and mobidity rate of 3-5% and 30-50% respectively.
The risk of developing an incisional hernia after a laparoscopic cholecystectomy is about 8% in patients over 50 years of age.
Patients with gallstones in the gallbladder have an associated choledochlithiasis (stone in the common bile duct) in 10-15% of the time.^[3]

↑ McSherry CK, Ferstenberg H, Calhoun WF, Lahman E, Virshup M (1985). "The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients". Ann. Surg. 202 (1): 59–63. PMC 1250837. PMID 4015212.
↑ Friedman GD (1993). "Natural history of asymptomatic and symptomatic gallstones". Am. J. Surg. 165 (4): 399–404. PMID 8480871.
↑ Julliard O, Hauters P, Possoz J, Malvaux P, Landenne J, Gherardi D (2016). "Incisional hernia after single-incision laparoscopic cholecystectomy: incidence and predictive factors". Surg Endosc. 30 (10): 4539–43. doi:10.1007/s00464-016-4790-4. PMID 26895902.