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No need to be galled by gallstones.

Approximately 20 million people in the United States have gallstones, with about 1 million new cases each year. Surgeons remove 500,000 gallbladders each year because of stones, making this the most common digestive disease among hospital admissions. with an average length of six days.

Most gallstones remain asymptomatic for years, and many never cause symptoms. When they do, however, the complications can be quite severe. These range from intense pain of a few hours (biliary colic) to life-threatening conditions such as acute cholecystitis (inflammation of the gallbladder) and pancreatitis (inflammation of the adjacent pancreas). Until two years ago, major abdominal surgery to remove the gallbladder was the usual treatment-- with a five-day hospital stay and recovery period of three to five weeks. Nonsurgical treatment (oral medication to dissolve the stones. injection of such drugs through a catheter inserted into the gallbladder. and shock-wave treatments to break up the stones) sometimes worked. However. because the gallbladder remained, stones recurred in about half the cases.

Some time ago, we reported on a new technique, laparoscopic cholecystectomy. that was introduced in France and the United States in 1989. This procedure. which involved only three small incisions in the abdomen rather than one large one, reduced hospitalization to just an overnight stay. with only three to five days of recuperation.

In just three years, some 25,000 surgeons have received training in the technique. and 80 percent of gallbladders are now being removed in this manner. However, because the procedure came into demand so rapidly, there has never been a major study to compare the safety and efficacy of laparoscopic removal of the gallbladder with the standard surgical procedure.

Because of the popularity of the new technique with patients, it is not likely that a randomized trial, in which half the patients receive the new therapy and half the old, can now be done. The National Institute of Diabetes and Digestive and Kidney Diseases will hold a conference this September to discuss whether the new technique is as safe and effective as the standard surgical procedure. All interested doctors are invited to attend.
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Publication:Medical Update
Date:Aug 1, 1992
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