title: Black bile of melancholy or gallstones of biliary colics: historical perspectives on cholelithiasis.
abstract: Barely 130 years after its first description, cholecystectomies are among the most commonly performed surgeries in the USA. The success of this operation with subsequent technical improvements, such as laparoscopic approaches, caused a paradigm shift in the management of gallstone disease. However, symptoms persist in 10-40 % of successfully operated patients. Reviewing monographs, textbooks, and articles published during the last 300 years, several important factors emerge as likely contributors to limited or poor treatment responses. Early on, clinicians recognized that cholelithiasis is quite common and thus often an incidental finding, especially if patients present with vague or atypical symptoms. Consistent with these observations, patients with such atypical symptoms are less likely to benefit from cholecystectomy. Similarly, lasting improvements are more reliably seen in patients with symptoms of presumed biliary origin and documented gallstones compared to individuals without stones, an important point in view of increasing rates of surgery for biliary dyskinesia. While cholelithiasis can cause serious complications, the overall incidence of clinically relevant problems is so low that prophylactic cholecystectomy cannot be justified. This conclusion corresponds to epidemiologic data showing that the rise in elective cholecystectomies decreased hospitalizations due to gallstone disease, but was associated with a higher volume of postoperative complications, ultimately resulting in stable combined mortality due to gallstone disease and its treatment. These trends highlight the tremendous gains in managing gallstone disease, while at the same time reminding us that the tightening rather than expanding indications for cholecystectomy may improve outcomes.
authors.affiliation: Division of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA, 15213, USA, bielefeldtk@upmc.edu.
authors.forename: Klaus
authors.initials: K
authors.lastname: Bielefeldt
mesh_terms: D000375:Aging; D002763:Cholecystectomy / Q000266:history* / Q000379:methods; D002769:Cholelithiasis / Q000266:history* / Q000473:pathology / Q000601:surgery; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans
references.citation: World J Gastroenterol. 2008 Sep 14;14(34):5282-9
references.pmid: 18785280
references.citation: Gastrointest Endosc. 2014 May;79(5):765-72
references.pmid: 24472759
references.citation: J Laparoendosc Adv Surg Tech A. 2005 Oct;15(5):439-42
references.pmid: 16185113
references.citation: Proc R Soc Med. 1908;1(Surg Sect):93-106
references.pmid: 19973343
references.citation: CMAJ. 1996 Feb 15;154(4):491-500
references.pmid: 8630838
references.citation: JAMA. 1993 Sep 22-29;270(12):1429-32
references.pmid: 8371441
references.citation: Cal West Med. 1926 Jan;24(1):60-2
references.pmid: 18739854
references.citation: JAMA. 2013 Aug 28;310(8):812-20
references.pmid: 23982367
references.citation: Br Med J. 1907 Oct 26;2(2443):1117-8
references.pmid: 20763501
references.citation: Ann Surg. 1940 May;111(5):831-7
references.pmid: 17857585
references.citation: Bull N Y Acad Med. 1944 Apr;20(4):203-19
references.pmid: 19312391
references.citation: Dig Dis Sci. 2013 Apr;58(4):1062-73
references.pmid: 23456496
references.citation: Arch Surg. 2011 Oct;146(10):1143-7
references.pmid: 22006872
references.citation: J Gastrointest Surg. 2009 Feb;13(2):304-11
references.pmid: 18923876
references.citation: Can Med Assoc J. 1911 Sep;1(9):832-41
references.pmid: 20310190
references.citation: Ann Hepatol. 2011 Jul-Sep;10(3):306-14
references.pmid: 21677332
references.citation: Dig Dis Sci. 1999 Jul;44(7):1322-9
references.pmid: 10489913
references.citation: Gut. 1984 Oct;25(10):1029-33
references.pmid: 6479677
references.citation: Am J Surg. 2003 Feb;185(2):91-5
references.pmid: 12559435
references.citation: Cal State J Med. 1913 Aug;11(8):310-3
references.pmid: 18736006
references.citation: Int J Surg. 2010;8(1):15-7
references.pmid: 19857610
references.citation: Surg Endosc. 1997 Sep;11(9):933-5
references.pmid: 9294276
references.citation: Am Surg. 2011 Aug;77(8):1014-20
references.pmid: 21944516
references.citation: N Engl J Med. 1994 Feb 10;330(6):403-8
references.pmid: 8284007
references.citation: Dig Dis Sci. 2000 Dec;45(12):2392-8
references.pmid: 11258564
references.citation: Gut. 1991 Mar;32(3):316-20
references.pmid: 2013429
references.citation: J Clin Epidemiol. 1997 Dec;50(12):1347-55
references.pmid: 9449938
references.citation: Dig Liver Dis. 2008 Dec;40(12):944-50
references.pmid: 18406218
references.citation: Br Med J. 1929 Mar 9;1(3557):437-9
references.pmid: 20774523
references.citation: Surgeon. 2013;11 Suppl 1:S14-8
references.pmid: 23178001
references.citation: Dig Dis Sci. 1994 Aug;39(8):1704-7
references.pmid: 8050321
references.citation: Gastroenterology. 1999 Apr;116(4):900-5
references.pmid: 10092312
references.citation: Eur J Surg. 1994 Nov;160(11):605-11
references.pmid: 7858045
references.citation: Br Med J. 1927 Apr 2;1(3456):614-5
references.pmid: 20773106
references.citation: World J Gastroenterol. 2005 Nov 21;11(43):6800-6
references.pmid: 16425387
references.citation: Can Med Assoc J. 1964 Sep 5;91:564-5
references.pmid: 14176066
references.citation: Psychosom Med. 2010 Feb;72(2):198-205
references.pmid: 20064903
references.citation: J Gastroenterol Hepatol. 2002 Jun;17(6):702-7
references.pmid: 12100617
references.citation: Surg Endosc. 2001 Jul;15(7):700-5
references.pmid: 11591971
references.citation: Am J Gastroenterol. 2014 Mar;109(3):436-42
references.pmid: 24445573
references.citation: Am J Epidemiol. 1987 Nov;126(5):912-21
references.pmid: 3310613
references.citation: Br J Surg. 2012 Jun;99(6):864-9
references.pmid: 22407811
references.citation: Am J Surg. 1993 Apr;165(4):420-6
references.pmid: 8480874
references.citation: Eur J Epidemiol. 1994 Apr;10(2):143-50
references.pmid: 7813691
references.citation: Arch Surg. 2009 Dec;144(12):1108-14
references.pmid: 20026827
references.citation: Br J Surg. 2014 May;101(6):677-84
references.pmid: 24664658
references.citation: Br Med J. 1907 Mar 23;1(2412):676-80
references.pmid: 20763136
references.citation: Br J Gen Pract. 2004 Aug;54(505):574-9
references.pmid: 15296554
references.citation: Am Surg. 2013 Jun;79(6):553-60
references.pmid: 23711262
references.citation: Ann Surg. 1939 Apr;109(4):580-7
references.pmid: 17857346
references.citation: Dig Dis Sci. 2013 Oct;58(10):2799-808
references.pmid: 23934412
references.citation: Cleve Clin J Med. 2011 Mar;78(3):171-8
references.pmid: 21364161
references.citation: Gastroenterology. 1984 Nov;87(5):1154-9
references.pmid: 6479537
references.citation: Digestion. 1983;28(3):153-7
references.pmid: 6667780
references.citation: Ann Surg. 1917 Jul;66(1):69-71
references.pmid: 17863748
references.citation: Minim Invasive Surg. 2014;2014:635461
references.pmid: 24790759