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 .
Is biliary pain exclusively related to gallbladder stones? A controlled prospective study.
BACKGROUND The uncertainty around true clinical manifestations of gallbladder stone disease is in contrast with the unanimous recommendation that only symptomatic gallstones should be treated . AIM To evaluate the relationship between biliary pain , other gastrointestinal symptoms and gallstones . DESIGN OF STUDY A pragmatic , prospect i ve cohort question naire study . SETTING Seventy-five general practice s in Rotterdam , The Netherl and s. METHOD All patients suspected by their general practitioner ( GP ) to have gallstone disease underwent ultrasound examination of the upper abdomen .  Using a self-administered question naire , the presence of 11 gastrointestinal symptoms was assessed at inclusion and after 1 year . Likelihood ratios ( LRs ) for the presence of gallstones and symptom relief rates after 1 year were calculated . The mean difference in health status at inclusion and after follow-up was calculated for patients without gallstones , for patients with gallstones who were operated on and for patients with gallstones who were not operated on . RESULTS In total , 61 % of the patients with gallstones diagnosed by ultrasound scan reported biliary pain , as did 45 % of the patients without gallstones ( LR = 1.34 , 95 % confidence interval [ CI ] = 1.05 to 1.71 ) . Patients operated on for gallstone disease did not show significant relief of biliary pain compared to patients not operated on for gallstones or patients without gallstones ( 87 % , 63 % and 83 % , respectively ) . Health status improved in all patients . The mean improvement in health status did not differ between the three patient groups . GPs were able to discriminate between patients with high and low probability of gallbladder stones by ultrasound examination ( 53 % versus 23 % ) . This selection , however , did not predict the outcome of cholecystectomy . CONCLUSION Neither biliary pain nor any other gastrointestinal symptom was consistently related to gallstone disease . Therefore , the indication for elective cholecystectomy can not be based on the presence of biliary pain alone . Relief of biliary pain in patients operated on for gallstones should not simply be attributed to a successful 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 .