Gallstones are common and occur asymptomatically or symptomatically with or without complications. Treatment is only required for symptomatic
gallstones and complications in
gallstones.
Laparoscopic cholecystectomy is the treatment of choice for symptomatic
gallstones and is performed with an increasing frequency. One may fear, that the indications for
cholecystectomy have changed, and surgery is now undertaken for a lesser degree of morbidity.
Cholecystectomy does not increase life expectancy, and 20-30% of patients cholecystectomized for symptomatic
gallstones complain of
abdominal pain of unknown origin after the operation. New valid parameters in order to predict which patients will benefit from
cholecystectomy are therefore necessary. Symptoms specific to
gallstones are not precisely known, and greatest success in treatment seems to be related to the occurrence of severe, often steady
pain, of hours' duration, often located in the epigastrium or upper right quadrant, with or without radiation and/or
vomiting.
Dyspepsia alone is not an indication for
cholecystectomy. Psychological vulnerability may predict a poor outcome after
cholecystectomy and should lead to reconsideration of the indication for surgery.