TREATING GALL-STONES

Widespread use of echography and laparoscopic surgery has caused a revolution in the treatment of gall stones. The question now is which patients should be treated, and when and how? One clear answer concerns asymptomatic cases: no one. The only patients which might benefit from ''prophylactic cholecystectomy'' are potential graft recipients, although no evaluation has been performed. For cholesterol stones, drugs can be effective if the bladder functions correctly. Their effect can sometimes be accelerated with extracorporal lithotripsy. The indications of intracorporal lithotripsy are limited by the risks involved. But the big breakthough came with laparoscopic procedures, now performed by nearly all surgeons because of the major improvements in patient comfort. This new technique reduces abdominal pain and scar tissue formation with the subsequent gain in hospitalization time. In the very near future, laparoscopic cholecystectomy will undoubtedly be considered the reference surgical technique, although until the question of systematic peroperative opacification of the main bile duct has been totally solved, traditional laparotomy will continue to have first intention indications.