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 .
Gallbladder motor function in gallstone patients: sonographic and in vitro studies on the role of gallstones, smooth muscle function and gallbladder wall inflammation.
Gallbladder motility was studied by ultrasound in 100 healthy adult volunteers and 150 gallstone patients , in a subgroup of whom gallstone burden , type and number , gallbladder histology and tensiometric responses of gallbladder strips to cholecystokinin octapeptide  were evaluated . Patients were divided into contractors ( n = 108 ) and hypocontractors ( n = 42 ) , according to their gallbladder motility pattern in vivo . Contractors showed slower gallbladder emptying and increased fasting and postpr and ial residual volumes , although the ejected amount of bile was greater than that of controls ( 20.2 + /- SEM 1.1 vs 16.0 + /- 0.7 ml ; p < 0.001 ) . In contrast , hypocontractors exhibited slower and less complete gallbladder emptying than controls with a reduction in the absolute amount of ejected bile . Although gallbladder wall inflammation was mild and comparable in specimens from both groups of patients , the thickness of the muscular layer was greater in hypocontractors than in contractors ( 1073 + /- 76 vs 745 + /- 75 microns , p < 0.01 ) and related inversely to postpr and ial ejected volume ( r = -0.42 ; p < 0.03 ; n = 32 ) but positively to gallstone volume ( r = 0.40 ; p < 0.03 ; n = 32 ) . Compared to contractors , gall-bladder muscle strips of hypocontractors exhibited a decrease in frequency and amplitude of spontaneous contraction and in maximal stress and receptor sensitivity to cholecystokinin octapeptide ( 0.1 nM-1 microM ) . Postpr and ial gallbladder evaculation was unaffected by stone number , and by the presence or absence of stone calcification . Gallstone volume was larger in hypocontractors ( 19.4 + /- 3.0 ml vs 9.6 + /- 0.9 ml , p < 0.001 ) than contractors . The comparison of in vitro contractility patterns between cholesterol , mixed and pigment stone patients showed a more severe defect in patients with cholesterol and mixed stones than in those with pigment calculi . In conclusion , in gallstone patients : ( i ) gallbladder motor dysfunction manifests mainly with increased fasting and postpr and ial residual volumes in contractors and with markedly increased postpr and ial residual volumes and decreased gallbladder emptying in hypocontractors ; ( ii ) gallbladder kinetics seem to be influenced by stone volume and cholesterol content of calculi but not stone number , calcification or mild chronic cholecystitis ; ( iii ) a form of hypertrophic leiomyopathy is observed in gallstone patients with the most impaired gallbladder motor function
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 .