Treatment: Cholelithiasis

In asymptomatic pts, risk of developing complications requiring surgery is small. Elective cholecystectomy should be reserved for: (1) symptomatic pts (i.e., biliary colic despite low-fat diet); (2) persons with previous complications of cholelithiasis (see below); and (3) presence of an underlying condition predisposing to an increased risk of complications (calcified or porcelain gallbladder). Pts with gallstones >3 cm or with an anomalous gallbladder containing stones should also be considered for surgery. Laparoscopic cholecystectomy is minimally invasive and is the procedure of choice for most pts undergoing elective cholecystectomy. Oral dissolution agents (ursodeoxycholic acid) partially or completely dissolve small radiolucent stones in 50% of selected pts within 6-24 months. Because of the frequency of stone recurrence and the effectiveness of laparoscopic surgery, the role of oral dissolution therapy has been largely confined to pts who are not candidates for elective cholecystectomy.