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 .
[Acute cholecystitis: timing of surgery].
The authors report their own experience about 156 cases of acute cholecystitis observed between January 1991 and October 1992 . The most part of the patients were between 30 and 65 years old ( 84 cases observed ) . In 27 cases , for the positive evolution of the pathology , it was put on practice a non operative treatment . The other 129 cases were treated surgically . The patients with lithiasic cholecystitis were 148 ; those affected by non lithiasic cholecystitis were 5 ; and 3 of them presented an acute cholecystitis as a manifestation of a carcinoma . Between the various diagnostic methods , the echography , executed in emergency , is considered as an indispensable one , for having changed completely the diagnostic approach . It is discussed , particularly , the timing of surgery , an aspect able to influence considerably the therapeutic iter and its results . There are analysed the criteria for whom some authors are favourable to a medical treatment of the acute cholecystitis , postponing the operation , while other of them are favourable to an early surgical treatment . The authors ' casuistry put in evidence 110 operations effectuated in emergency ( < 12 hours ) , 19 operations after an 12 - 72 hours interval , no operations at a long distance ( 1 - 10 months ) . The results are to be considered satisfactory : 1 deceased ( on 129 operated cases , 0.78 % ) ; 10 immediate complications ( 7.75 % ) : 8 suppurations of the wound , 1 biliar fistula and 1 internal hemorrhage after video-laparoscopic operation ; 2 late complications ( 1.55 % ) : they were relapsing gallstones . The aim of this work is to offer a contribution to codification of the treatment of the acute cholecystitis , on the ground of the acquired experience
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 .