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 .
Relationship between persistence of abdominal symptoms and successful outcome after cholecystectomy.
BACKGROUND Patients frequently have persistent abdominal symptoms after undergoing cholecystectomy .  The relationship between abdominal symptoms and biliary dysfunction is often unclear . OBJECTIVES To describe the persistence rate of abdominal symptoms in a large cohort of patients after elective cholecystectomy  , to identify predictors of symptom persistence and operative success , to underst and which symptoms improve after cholecystectomy , and to describe the important determinants of an unsuccessful operation . METHODS Secondary analysis of a prospect i ve , multisite cohort study of 2481 patients undergoing elective cholecystectomy .  RESULTS The mean + /- SD number of abdominal symptoms per patient decreased from 3.1 + /- 2.0 to 1.1 + /- 1.3 ; 27 % of patients who identified a symptom as most bothersome before surgery still had the symptom 6 months after surgery . Symptom persistence rates ranged from 5.6 % ( vomiting ) to 40.2 % ( gas/flatulence ) . A balance score that quantified the abdominal symptom mix between dyspeptic and biliary symptoms shifted after surgery to the dyspeptic category . Predictors of persistence of a most bothersome symptom were dyspeptic symptom category , worse operative risk and self-rated health status , symptom duration longer than 6 months , and no previous episodes of acute cholecystitis . The major correlate of not achieving a very successful outcome ( 15.2 % of patients ) was the presence of postoperative abdominal pain . Other predictors included worse self-rated health status and physical functioning , symptom duration longer than 6 months before surgery , and no previous episodes of acute cholecystitis . CONCLUSIONS Symptoms categorized as dyspeptic were more likely to persist than were biliary symptoms , although all symptoms showed a decrease in prevalence after cholecystectomy . More attention to the rationale for gallbladder removal and clarification of patient expectations for symptom relief might be necessary to improve outcomes after elective 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 .