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
Gallstone disease patients should not undergo an elective cholecystectomy until symptoms develop, since almost 55% of patients will remain asymptomatic. Also, the complications of asymptomatic gallstones are almost negligible unless symptoms develop. The complications of gallstone disease include acute cholecystitis, obstructive jaundice, acute cholangitis and acute pancreatitis. The prognosis after laparoscopic cholecystectomy is excellent with morbidity and mortality rates being as low as 0.5 and 10% respectively.
Natural History, Complications, and Prognosis
Natural History
- 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]
Complications
- Common complications of gallstone disease include:
- Acute cholecystitis
- Gallbladder perforation
- Obstructive jaundice
- Choledocholithiasis with or without acute cholangitis
- Gallbladder fistula
- Cholangiocarcinoma
- Gallstone pancreatitis
- Gallstone ileus[2]
Prognosis
- 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]
References
- ↑ 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.