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 .
Symptomatic outcome 1 year after laparoscopic and minilaparotomy cholecystectomy: A randomized trial
In a r and omized controlled trial , 299 patients were sent a symptoms question naire 1 year after laparoscopic ( n = 151 ) or minilaparotomy ( n = 148 ) cholecystectomy for symptomatic cholelithiasis . The response rate to the question naire from contactable patients was 86 per cent . In both groups , at least 90 per cent of patients reported that their symptoms were improved , and at least 93 per cent rated the success of their operation as ‘ excellent ’ , ‘ good ’ , or ‘ fair ’ . However , over half the patients reported abdominal pain , a quarter reported flatulence , and a quarter dyspepsia . The only difference between treatment groups was that a higher proportion of patients who underwent minilaparotomy  reported heartburn ( 35 per cent versus 19 per cent , P = 0±005 ) . Patients who reported a ‘ poor ’ outcome were more likely to have suffered a postoperative complication , had lower quality of life scores , and higher anxiety and depression scores . Both laparoscopic and minilaparotomy cholecystectomy result in symptomatic benefit in at least 90 per cent of patients with symptomatic cholelithiasis
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 .