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 response to gallstone treatment--problems and surprises.
OBJECTIVE To re-evaluate after 5 years the results of a r and omised trial of cholecystectomy and lithotripsy for the treatment of symptomatic gallstones . DESIGN Late follow-up of a r and omised controlled trial . SETTING Teaching hospital , UK . SUBJECTS 144 of the 179 patients originally r and omised . INTERVENTIONS Either elective open cholecystectomy under general anaesthesia or a maximum of 4 sessions of lithotripsy ( up to 3000 shocks/session ) on consecutive days with no anaesthesia or analgesia . RESULTS Of the original 87 patients r and omised to be treated by lithotripsy , 39 ( 45 % ) subsequently underwent cholecystectomy , most of them within 32 months of treatment ( " crossover " group ) . Patients in both main groups had a pronounced reduction in the number of episodes of pain at 5 years and significant reductions in the mean severity scores both on VAS and the McGill rating . Those in the crossover group had the worst scores . Gastrointestinal symptoms improved in the two main groups , but again the crossover group did least well . Quality of life improved significantly over baseline in the two main groups , but was much poorer in the crossover group . CONCLUSIONS Patients who had primary cholecystectomy were more likely to be free of pain than those treated by lithotripsy . Lithotripsy gave good symptomatic results in 55 % of patients , and this was not dependent on clearance of stones . Patients who had a cholecystectomy after lithotripsy had the worst symptomatic results . It is difficult to identify patients who will not benefit from lithotripsy , but the presence of many coexisting symptoms may be an important predictor
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 .