The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease.
The recent introduction of laparoscopic cholecystectomy (LAPC) has revolutionised the surgical treatment of gallstone disease. However, it has also raised doubts about the future role of extracorporeal shock wave lithotripsy (ESWL) in the treatment of gallstones. In this study, we compared patients treated successfully with ESWL and dissolution therapy with patients treated by LAPC. Out of 67 patients, 50 had successful clearance with ESWL while 50 out of 54 had successful LAPC. We evaluate treatment duration, recurrence rate (ESWL) and cost of treatment in both groups. All patients had uncomplicated symptomatic gallstones. The inclusion criteria were similar in both groups with the exception of patients with non-functioning gallbladders who were excluded from ESWL. The results of the study show that although ESWL is noninvasive and associated with minimal morbidity, it is also costly and has a high failure and recurrence rate. In contrast, laparoscopic cholecystectomy, while requiring short-term hospital stay and debility, seems to be a safe and effective alternative with an advantage in terms of cost and duration of treatment.
Darzi
A
A
Department of Surgery, Meath and Adelaide Hospitals and Trinity College, Dublin.
Geraghty
J G
JG
Williams
N N
NN
Sheehan
S S
SS
Tanner
A N
AN
Keane
F B
FB
D000328:Adult; D000368:Aged; D001647:Bile Acids and Salts / Q000627:therapeutic use; D017081:Cholecystectomy, Laparoscopic / Q000191:economics; D002769:Cholelithiasis / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D017721:Hospital Costs; D006801:Humans; D008096:Lithotripsy / Q000191:economics; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012008:Recurrence
D001647:Bile Acids and Salts