title: Long term response to gallstone treatment--problems and surprises.
abstract: OBJECTIVE
  To re-evaluate after 5 years the results of a randomised trial of cholecystectomy and lithotripsy for the treatment of symptomatic gallstones.
  
  
  METHODS
  Late follow-up of a randomised controlled trial.
  
  
  METHODS
  Teaching hospital, UK.
  
  
  METHODS
  144 of the 179 patients originally randomised.
  
  
  METHODS
  Either elective open cholecystectomy under general anaesthesia or a maximum of 4 sessions of lithotripsy (up to 3000 shocks/session) on consecutive days with no anaesthesia or analgesia.
  
  
  RESULTS
  Of the original 87 patients randomised to be treated by lithotripsy, 39 (45%) subsequently underwent cholecystectomy, most of them within 32 months of treatment ("crossover" group). Patients in both main groups had a pronounced reduction in the number of episodes of pain at 5 years and significant reductions in the mean severity scores both on VAS and the McGill rating. Those in the crossover group had the worst scores. Gastrointestinal symptoms improved in the two main groups, but again the crossover group did least well. Quality of life improved significantly over baseline in the two main groups, but was much poorer in the crossover group.
  
  
  CONCLUSIONS
  Patients who had primary cholecystectomy were more likely to be free of pain than those treated by lithotripsy. Lithotripsy gave good symptomatic results in 55% of patients, and this was not dependent on clearance of stones. Patients who had a cholecystectomy after lithotripsy had the worst symptomatic results. It is difficult to identify patients who will not benefit from lithotripsy, but the presence of many coexisting symptoms may be an important predictor.
authors.affiliation: University Department of Surgical and Anaesthetic Sciences, University of Sheffield, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Ahmed
authors.forename: J V
authors.initials: JV
authors.lastname: Freeman
authors.forename: B
authors.initials: B
authors.lastname: Ross
authors.forename: B
authors.initials: B
authors.lastname: Kohler
authors.forename: J P
authors.initials: JP
authors.lastname: Nicholl
authors.forename: A G
authors.initials: AG
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000368:Aged; D002763:Cholecystectomy; D002769:Cholelithiasis / Q000150:complications / Q000601:surgery / Q000628:therapy*; D018592:Cross-Over Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008096:Lithotripsy; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology; D010147:Pain Measurement; D011788:Quality of Life; D012720:Severity of Illness Index; D016896:Treatment Outcome