Page 7 - 05- Cholelithiasis

<50% of patients with gallstones become symptomatic.
Cholecystectomy-related mortality is <0.5% in elective cases and 3–5% in emergency cases;
morbidity is <10% in elective cases and 30–40% in emergency cases.
~10–15% of patients have associated choledocholithiasis.
After cholecystectomy, stones may recur within the biliary tree in patients with associated risk
factors.

COMPLICATIONS
Acute cholecystitis (90–95% secondary to gallstones)
GP; ERCP ±; sphincterotomy of no clear benefit in patients with mild GP but reduces
complications in those with severe GP (4)[A]
CBD stones with obstructive jaundice and acute cholangitis. In patients undergoing ERCP for
CBD stones, early LC reduces the risk of recurrent biliary events (5)[B].
Biliary-enteric fistula and gallstone ileus
Bouveret syndrome is a variant of gallstone ileus where the gallstone lodges in the duodenum
or pylorus causing a gastric outlet obstruction.
Gallbladder cancer
Mirizzi syndrome (extrinsic bile duct obstruction caused by gallstones lodged in gallbladder or
cystic duct)

REFERENCES

1. Sanabria A, Dominguez LC, Valdivieso E, et al. Antibiotic prophylaxis for patients
undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev. 2010;
(12):CD005265.
2. Gurusamy KS, Koti R, Fusai G, et al. Early versus delayed laparoscopic cholecystectomy for
uncomplicated biliary colic. Cochrane Database Syst Rev. 2013;(6):CD007196.
3. Gurusamy KS, Davidson C, Gluud C, et al. Early versus delayed laparoscopic
cholecystectomy for people with acute cholecystitis. Cochrane Database Syst Rev. 2013;
(6):CD005440.
4. Burstow MJ, Yunus RM, Hossain MB, et al. Meta-analysis of early endoscopic retrograde
cholangiopancreatography (ERCP) ±; endoscopic sphincterotomy (ES) versus conservative
management for gallstone pancreatitis (GSP). Surg Laparosc Endosc Percutan Tech.
2015;25(3):185–203.
5. Huang RJ, Barakat MT, Girotra M, et al. Practice patterns for cholecystectomy after
endoscopic retrograde cholangiopancreatography for patients with choledocholithiasis.
Gastroenterology. 2017;153(3):762.e2–771.e2.

ADDITIONAL READING

Brown LM, Rogers SJ, Cello JP, et al. Cost-effective treatment of patients with symptomatic
cholelithiasis and possible common bile duct stones. J Am Coll Surg. 2011;212(6):1049.e1–
1060.e7.
Keus F, Gooszen HG, van Laarhoven CJ. Open, small-incision, or laparoscopic
cholecystectomy for patients with symptomatic cholecystolithiasis. An overview of Cochrane
Hepato-Biliary Group reviews. Cochrane Database Syst Rev. 2010;(1):CD008318.