The results of the economic evaluation suggest that , on average , the surgery strategy costs £ 1236 more per patient than the conservative management strategy but was , on average , more effective .
An increase in the number of people requiring surgery while treated conservatively corresponded to a reduction in the cost-effectiveness of the conservative strategy .
The results of this assessment indicate that cholecystectomy is still the treatment of choice for many symptomatic people .
However , approximately half of the people in the observation group did not require surgery or suffer complications in the long term indicating that a conservative therapeutic approach may represent a valid alternative to surgery in this group of people .
BACKGROUND Approximately 10 - 15 % of the adult population suffer from gallstone disease , cholelithiasis , with more women than men being affected .
Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones .
However , some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis .
As most of the current research focuses on the surgical management of the disease , less attention has been dedicated to the consequences of conservative management .
OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of  cholecystectomy  compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones ( biliary pain ) or cholecystitis .
From acute to chronic pain after laparoscopic cholecystectomy: A prospective follow-up analysis
Objective . The pathogenesis and risk of chronic pain after cholecystectomy are unknown . In this prospect i ve study of 150 consecutive patients undergoing laparoscopic cholecystectomy  , the preoperative clinical data , cold pressor test , state of neuroticism and early postoperative pain intensity were assessed . Material and methods . Follow-up question naires were sent to all patients 1 year after surgery . Patients with moderate/severe chronic pain were interviewed and invited to participate in a structured examination programme . Results . The question naire response rate was 100 % . Twenty patients reported moderate or severe chronic pain . The 1-year in-office interview revealed that two patients without chronic pain had misinterpreted the question naire . Sixteen patients were enrolled for the examination programme . Demonstrable pathology explained the aetiology of chronic pain in 8 patients ( 5 % ) ; another 8 patients with moderate ( n=6 ) or severe ( n=2 ) chronic pain were without pathological findings . In total , 132 patients had no chronic pain . Chronic pain patients suffered significantly more intense acute postoperative pain compared with those without chronic pain ( p≤0.05 ) . The incidence of chronic pain patients was higher in the group of patients with intense acute postoperative pain than in patients with low acute postoperative pain ( p = 0.030–0.063 ) . Development of chronic pain was not statistically related to a preoperative cold pressor nociceptive stimulus , preoperative state of neuroticism or to any other variables examined . Conclusions . The risk of significant chronic pain after laparoscopic cholecystectomy for symptomatic cholecystolithiasis is low but was significantly associated with the intensity of acute postoperative pain . Patients should be carefully examined to exclude somatic causes of chronic pain after laparoscopic cholecystectomy
The results of the economic evaluation suggest that , on average , the surgery strategy costs £ 1236 more per patient than the conservative management strategy but was , on average , more effective .
An increase in the number of people requiring surgery while treated conservatively corresponded to a reduction in the cost-effectiveness of the conservative strategy .
The results of this assessment indicate that cholecystectomy is still the treatment of choice for many symptomatic people .
However , approximately half of the people in the observation group did not require surgery or suffer complications in the long term indicating that a conservative therapeutic approach may represent a valid alternative to surgery in this group of people .
BACKGROUND Approximately 10 - 15 % of the adult population suffer from gallstone disease , cholelithiasis , with more women than men being affected .
Cholecystectomy is the treatment of choice for people who present with biliary pain or acute cholecystitis and evidence of gallstones .
However , some people do not experience a recurrence after an initial episode of biliary pain or cholecystitis .
As most of the current research focuses on the surgical management of the disease , less attention has been dedicated to the consequences of conservative management .
OBJECTIVES To determine the clinical effectiveness and cost-effectiveness of  cholecystectomy  compared with observation/conservative management in people presenting with uncomplicated symptomatic gallstones ( biliary pain ) or cholecystitis .