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 .
Pain persists in many patients five years after removal of the gallbladder: Observations from two randomized controlled trials of symptomatic, noncomplicated gallstone disease and acute cholecystitis
After removal of the gallbladder , pain may persist in some patients . To study this condition , 124 patients from two r and omized trials , including those with symptomatic noncomplicated gallbladder stones ( n = 90 ) and acute cholecystitis ( n = 34 ) , were interviewed , while 139 patients ( 90 % ) excluded from both trials responded to a question naire 5 years after the operation . Thirty-four patients ( 27 % ) of those r and omized had pain ; 23 ( 18 % ) had diffuse , steady pain ; and 11 ( 9 % ) had pain attacks resembling their preoperative symptoms . Asignificant dominance of diffuse pain occurred inwomen(P = 0.024 ) , especially those younger than 60 years ( P = 0.004 ) . A tendency for the diffuse type to be dominant was also present in the group of female patients with symptomatic noncomplicated gallbladder stones ( P = 0.052 ) . Of the excluded patients , 18 % ( 25/139 ) had pain , but 88 % of them ( 96 % of the men and 87 % of the women ) were satisfied with the result of the operation . The overall number of patients with postoperative pain was 22 % ( 59/263 ) . We conclude that persisting abdominal pain 5 years after the operation was mainly of a nonspecific type , found mostly in younger women who had had noncomplicated gallstone disease . Eightyeight percent of the excluded patients declared themselves satisfied with the result of 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 .