Gallstone disease natural history, complications and prognosis

Gallstone disease patients should not undergo an elective cholecystectomy until symptoms develop, since almost 55% of patients will remain asymptomatic. Also, the complications of asymptomatic gallstones are almost negligible unless symptoms develop. The complications of gallstone disease include acute cholecystitis, obstructive jaundice, acute cholangitis and acute pancreatitis. The prognosis after laparoscopic cholecystectomy is excellent with morbidity and mortality rates being as low as 0.5 and 10% respectively.

• Gallstone disease usually develops in the third decade of life, and can start asymptomatically.^[1]
• Symptoms of biliary colic may develop such as abdominal pain, fever and, jaundice.
• If left untreated, only 10% of patients with gallstone disease may progress to develop symptoms.

• Common complications of gallstone disease include:^[2]
  • Acute cholecystitis
  • Gallbladder perforation
  • Obstructive jaundice
  • Choledocholithiasis with or without acute cholangitis
  • Gallbladder fistula
  • Cholangiocarcinoma
  • Gallstone pancreatitis
  • Gallstone ileus

• Elective cholecystectomy has a mortality rate and morbidity rate of 0.5% and 10% respectively.^[3]
• Emergent cholecystectomy has a mortality rate and morbidity rate of 3-5% and 30-50% respectively.
• The risk of developing an incisional hernia after a laparoscopic cholecystectomy is about 8% in patients over 50 years of age.
• Patients with gallstones in the gallbladder have an associated choledocholithiasis (stone in the common bile duct) in 10-15% of the time.

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