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 .
Long‐term gallbladder stone recurrence and risk factors after successful lithotripsy
Objective The risk of recurrence has limited the acceptability of conservative therapies of gallbladder stones . The aim of the present study was to determine the rate of stone recurrence and its risk factors , after successful shock‐wave lithotripsy . Design Prospect i ve ultrasound follow‐up at yearly intervals or whenever biliary pain was reported . Methods One hundred and fifty‐eight consecutive patients ( single stone , n = 130 ; two or three stones , n = 28 ) were followed up to 70 months ( median , 33 months ) after stone disappearance and discontinuation of ursodeoxycholic acid . Results Forty‐three patients developed recurrent stones . By actuarial analysis , the recurrence rates ( as a percent ) at 1 , 2 , 3 , 4 and 5 years were , respectively : 6 ± 2 , 14 ± 3 , 27 ± 4 , 35 ± 5 , and 44 ± 6 ( observed ± SE ) . Cox 's regression analysis identified high body mass indexes to be a risk factor ( P = 0.02 ) for newly formed stones . Having had a single primary stone did not seem to be protective . Fourteen of the 43 patients ( 33 % ) had early symptoms of recurrence . Thirty‐eight patients ( 89 % ) chose to undergo oral dissolution again , which was complemented by lithotripsy in eight patients ( 19 % ) . Conclusion The 5‐year gallbladder stone recurrence  after lithotripsy and ursodeoxycholic acid is not substantially smaller than that reported by post‐bile acid studies . Obesity is a risk factor for recurrent stones as it is for primary stones . Most patients with secondary stones choose to have conservative therapy again . Gallbladder stone recurrence still is one of the major drawbacks of these treatments and cost‐effective strategies are needed to prevent it . Eur J Gastroenterol Hepatol 12:209‐215 © 2000 Lippincott Williams & Wilkins European Journal of Gastroenterology & Hepatology 2000 ,
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 .