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Gallstone Disease in the Elderly

  • Chapter
Principles and Practice of Geriatric Surgery

Abstract

Disease of the biliary tract is common among adults in the United States: 10–15% of the adult population have gallstones, accounting for approximately 20 million people, and 1 million new cases are discovered annually. Gallstone disease is the most common and most costly digestive disease causing hospitalization, with an estimated annual cost exceeding $5 billion.1 Among the elderly, biliary disease is the most common indication for abdominal surgery.2 This is undoubtedly related to the progressive increase in the prevalence of cholelithiasis with advancing age, which in some reports exceeds 50% in those older than age 70.3 In addition to being common, gallbladder disease in the elderly is more severe than in the young, as indicated by the higher proportion of elderly patients requiring cholecystectomy for acute rather than chronic cholecystitis.4 Biliary tract disease in the elderly is further complicated by the greater incidence of choledocholithiasis. Common duct stones are found at the time of cholecystectomy in up to 30% of those in their sixties and in up to 50% of those in their seventies.5

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References

  1. National Institutes of Health. Consensus statement on gallstones and laparoscopic cholecystectomy. Am J Surg 1993;165:390–393.

    Article  Google Scholar 

  2. Sanson TG, O’Keefe KP. Evaluation of abdominal pain in the elderly. Emerg Med Clin North Am 1996;14:615–627.

    Article  PubMed  CAS  Google Scholar 

  3. Harness JK, Strodel WE, Talsma SE. Symptomatic biliary tract disease in the elderly patient. Am J Surg 1986;52:442–446.

    CAS  Google Scholar 

  4. Kahng KU, Roslyn JJ. Surgical Issues for the elderly patient with hepatobiliary disease. Surg Clin North Am 1994;74: 345–373.

    PubMed  CAS  Google Scholar 

  5. Krasman ML, Gracie WA, Strasius SR. Biliary tract disease in the aged. Clin Geriatr Med 1991;7:347–370.

    PubMed  CAS  Google Scholar 

  6. Rosenthal RA, Andersen DK. Surgery in the elderly: observations on the pathophysiology and treatment of cholelithiasis. Exp Gerontol 1993;28:459–472.

    Article  PubMed  CAS  Google Scholar 

  7. Cooper GS, Shlaes DM, Salata RA. Intraabdominal infection: differences in presentation and outcome between younger patients and the elderly. Clin Infect Dis 1994; 19:146–148.

    Article  PubMed  CAS  Google Scholar 

  8. Ingber S, Jacobson IM. Biliary and pancreatic disease in the elderly. Gastroenterol Clin North Am 1990;19:433–457.

    PubMed  CAS  Google Scholar 

  9. Sampliner RE, Bennett PH, et al. Gallbladder disease in Pima Indians: demonstrations of high prevalence and early onset by cholecystography. N Engl J Med 1970;283: 1358–1364.

    Article  PubMed  CAS  Google Scholar 

  10. Johnston DE, Kaplan MM. Pathogenesis and treatment of gallstones. N Engl J Med 1993;328:412–421.

    Article  PubMed  CAS  Google Scholar 

  11. Bowen JC, Brenner HI, Ferrante WA, et al. Gallstone disease: pathophysiology, epidemiology, natural history, and treatment options. Med Clin North Am 1992;76:1143–1157.

    PubMed  CAS  Google Scholar 

  12. Henriksson P, Einarsson K, Eriksson A, et al. Estrogen-induced gallstone formation in males: relation to changes in serum and biliary lipids during hormonal treatment of prostate carcinoma. J Clin Invest 1989;84:811–816.

    Article  PubMed  CAS  Google Scholar 

  13. Everson GT, McKinley C, Kern F Jr. Mechanisms of gallstone formation in women: effects of exogenous estrogen (Premarin) and dietary cholesterol on hepatic lipid metabolism. J Clin Invest 1991;87:237–246.

    Article  PubMed  CAS  Google Scholar 

  14. Tierney S, Pitt HA, Lillemoe KD. Physiology and pathophysiology of gallbladder motility. Surg Clin North Am 1993;73:1267–1290.

    PubMed  CAS  Google Scholar 

  15. Ratner J, Lisbona A, Rosenbloom M, et al. The prevalence of gallstone disease in very old institutionalized persons. JAMA 1991;265:902–903.

    Article  PubMed  CAS  Google Scholar 

  16. Giurgiu DI, Roslyn JJ. Treatment of gallstones in the 1990s. Prim Care Clin North Am 1996;23:497–513.

    CAS  Google Scholar 

  17. Trotman BW, Sotoway RD. Pigment vs cholesterol cholelithiasis: clinical epidemiological aspects. Dig Dis 1975;20:735–740.

    Article  CAS  Google Scholar 

  18. Pazzi P, Morsiani E, Sighinolfi D, et al. Pigment vs. cholesterol cholelithiasis: clinical and epidemiological aspects. Ital J Gastroenterol 1989;21:310.

    Google Scholar 

  19. Apstein MD, Carey MC. Pathogenesis of cholesterol gallstones: a parsimonious hypothesis. Eur J Clin Invest 1996;26:343–352.

    Article  PubMed  CAS  Google Scholar 

  20. Portincasa P, Stolk MF, Van Erpecum KJ, et al. Cholesterol gallstone formation in man and potential treatments of the gallbladder motility defect. Scand J Gastroenterol 1995; 30:63S-78S.

    Article  Google Scholar 

  21. Nilsell K, Angelin B, Liljeqvist L, et al. Biliary lipid output and bile acid kinetics in cholesterol gallstone disease: evidence for an increased hepatic secretion of cholesterol in Swedish patients. Gastroenterology 1985;89:287–293.

    PubMed  CAS  Google Scholar 

  22. Hofmann AR Bile acid secretion, bile flow and biliary lipid secretion in humans. Hepatology 1990;12:17S–22S.

    PubMed  CAS  Google Scholar 

  23. Carey MC, Duane WC. Enterohepatic circulation. In: Arias IM, Boyer JL. Fausto N, Jakoby WB, Schacter D, Shafritz DA (eds) The Liver, Biology and Pathobiology, 3rd ed. New York: Raven, 1994:719–767.

    Google Scholar 

  24. LaMont JT, Carey MC. Cholesterol gallstone formation. 2. Pathobiology and pathomechanics. Prog Liver Dis 1992; 10:165–191.

    Google Scholar 

  25. Smith JL, Hardie JR, Pillay SP, et al. Hepatic acylcoenzyme A: cholesterol acyltransferase activity is decreased in patients with cholesterol gallstones. J Lipid Res 1990; 31:1993–2000.

    PubMed  CAS  Google Scholar 

  26. Einarsson K, Nilsell K, Leijd B, et al. Influence of age on secretion of cholesterol and synthesis of bile acids by the liver. N Engl J Med 1985;313:277–282.

    Article  PubMed  CAS  Google Scholar 

  27. Thijs C, Knipschild P, Brombacher P. Serum lipids and gallstones: a case-control study. Gastroenterology 1990;98: 739–746.

    Google Scholar 

  28. Admirand WH, Small DM. The physicochemical basis of cholesterol gallstone formation in man. J Clin Invest 1968;47:1043–1052.

    Article  PubMed  CAS  Google Scholar 

  29. Holzbach RT, Marsh M, Olszewski M, et al. Cholesterol solubility in bile: evidence that supersaturated bile is frequent in healthy man. J Clin Invest 1973;52:1467–1479.

    Article  PubMed  CAS  Google Scholar 

  30. Holan KR, Holzbach RT, Hermann RE, et al. Nucleation time: a key factor in the pathogenesis of cholesterol gallstone disease. Gastroenterology 1979;77:611–617.

    PubMed  CAS  Google Scholar 

  31. Burnstein MJ, Ilson RG, Petrunka CN, et al. Evidence of a potent nucleating factor in the gallbladder bile of patients with cholesterol stones. Gastroenterology 1983;85:801–807.

    PubMed  CAS  Google Scholar 

  32. Sewell RB, Mao SJT, Kawamoto T, et al. Apolipoproteins of high, low and very low density lipoproteins in human bile. J Lipid Res 1983;24:391–401.

    PubMed  CAS  Google Scholar 

  33. Carey MC, Cahalane MJ. Whither biliary sludge? Gastroenterology 1988;95:508–523.

    PubMed  CAS  Google Scholar 

  34. Levy PR, Smith BF, LaMont JT. Human gallbladder mucin accelerates in vitro nucleation of cholesterol in artificial bile. Gastroenterology 1984;87:270–275.

    PubMed  CAS  Google Scholar 

  35. Lee SP, LaMont JT, Carey MC. Role of gallbladder mucin hypersecretion in the evolution of cholesterol gallstones: studies in the prairie dog. J Clin Invest 1981;67:1712–1723.

    Article  PubMed  CAS  Google Scholar 

  36. O’Leary DP, Murray FE, Turner BS, et al. Bile salts stimulate glycoprotein release by guinea pig gallbladder in vitro. Hepatology 1991;13:957–961.

    PubMed  Google Scholar 

  37. Strichartz SD, Abedin MZ, Abdou MS, et al. The effects of extracellular calcium on prairie dog gallbladder ion transport. J Lab Clin Med 1988;155:131–137.

    CAS  Google Scholar 

  38. Moser AJ, Abedin MZ, Roslyn JJ. Increased biliary protein precedes gallstone formation. Dig Dis Sci 1993;39:1313–1320.

    Article  Google Scholar 

  39. Shiffman ML, Sucermart HJ, Kellum JM, et al. Calcium in human gallbladder bile. J Lab Clin Med 1992:875–884.

    Google Scholar 

  40. Kaufman HS, Magnuson TH, Pitt HA, et al. The distribution of calcium salt precipitates in the core, periphery and shell of cholesterol, black pigment and brown pigment gallstones. Hepatology 1994;19:1124–1132.

    Article  PubMed  CAS  Google Scholar 

  41. Neithercut WD. Effect of calcium, magnesium and sodium ions on in vitro nucleation of human bile. Gut 1989; 30:665–670.

    Article  PubMed  CAS  Google Scholar 

  42. Kibe A, Dudley MA, Halpern Z, et al. Factors affecting cholesterol monohydrate crystal nucleation time in model systems of supersaturated bile. J Lipid Res 1985;26:1102–1111.

    PubMed  CAS  Google Scholar 

  43. Malet PF, Locke CL, Trotman BW, et al. The calcium ionophore A23187 stimulates glucoprotein secretion by the guinea-pig gallbladder. Hepatology 1986;6:569–573.

    Article  PubMed  Google Scholar 

  44. Plevris JN, Bouchier AD. Defective acid base regulation by the gallbladder epithelium and its significance for gallstone formation. Gut 1995;37:127–131.

    Article  PubMed  CAS  Google Scholar 

  45. Moser AJ, Abedin MZ, Cates JA, et al. Converting gallbladder absorption to secretion: the role of intracellular calcium. Surgery 1996;119:410–416.

    Article  PubMed  CAS  Google Scholar 

  46. Friedman GD, Kannel WB, Dawber TR. The epidemiology of gallbladder disease: observations in the Framingham study. J Chronic Dis 1996;19:273–292.

    Article  Google Scholar 

  47. Roslyn JJ, Pitt HA, Mann LL, Ament ME, DenBesten L. Gallbladder disease in patients on long-term parenteral nutrition. Gastroenterology 1993;84:148–154.

    Google Scholar 

  48. Ho KY, Weissberger AJ, Marbach P, Lazarus L. Therapeutic efficacy of the somatostatin analog SMS 201–995 (octreotide) in acromegaly. Ann Intern Med 1990;112:173–181.

    Article  PubMed  CAS  Google Scholar 

  49. Shaw SJ, Hajnal F, Lebovitz Y, et al. Gallbladder dysfunction in diabetes mellitus. Dig Dis Sci 1993;38:490–496.

    Article  PubMed  CAS  Google Scholar 

  50. Everson GT, Nemeth A, Kourourian S, et al. Gallbladder function is altered in sickle cell hemoglobinopathy. Gastroenterology 1989;96:1307–1316.

    PubMed  CAS  Google Scholar 

  51. Nino Murchia M, Burton D, et al. Gallbladder contractility in patients with spinal cord injuries: a sonographic investigation. AJR 1990;154:521–524.

    Article  Google Scholar 

  52. Masclee AA, Jansen JB, Dreissen WM, et al. Effect of truncal vagotomy on cholecystokinin release, gallbladder contraction, and gallbladder sensitivity to cholecystokinin in humans. Gastroenterology 1990;98:1338–1344.

    PubMed  CAS  Google Scholar 

  53. Patankar R, Ozmen MM, Bailey IS, et al. Gallbladder motility, gallstones, and the surgeon. Dig Dis Sci 1995;40:2323–2335.

    Article  PubMed  CAS  Google Scholar 

  54. Howard PJ, Murphy GM, Dowling RH. Gallbladder emptying patterns in response to a normal meal in healthy subjects and patients with gallstones: ultrasound study. Gut 1991;32:1406–1411.

    Article  PubMed  CAS  Google Scholar 

  55. Fisher RS, Rock E, Levin G, et al. Effects of somatostatin on gallbladder emptying. Gastroenterology 1987;92:885–890.

    PubMed  CAS  Google Scholar 

  56. Cameron AJ, Phillips SF, Summerskill WH. Effect of cholecystokinin, gastrin, secretin, and glucagon on human gallbladder in vitro. Proc Soc Exp Biol 1968;131:149.

    Google Scholar 

  57. Kalfin R, Milenov K. The effect of vasoactive intestinal polypeptide (VIP) on the canine gallbladder motility. Comp Biochem Physiol 1991;100:513–517.

    CAS  Google Scholar 

  58. Conter R, Roslyn JJ, Muller EL, et al. Effect of pancreatic polypeptide on gallbladder filling. J Surg Res 1985;38:461–467.

    Article  PubMed  CAS  Google Scholar 

  59. Conter R, Roslyn JJ, Taylor IL. Effects of peptide YY on gallbladder motility. Am J Physiol 1987;252:G736-G741.

    PubMed  CAS  Google Scholar 

  60. Lillimoe KD, Webb TH, Pitt HA. Neuropeptide Y: a candidate neurotransmitter for biliary motility. J Surg Res 1988;45:254–260.

    Article  Google Scholar 

  61. Jebbink MC, Masclee AA, Van der Klej FG, Schipper J, Rorati LC, Lamers CBHW. Effect of loxiglumide and atropine on erythromycin induced reduction in gallbladder volume in human subjects. Hepatology 1992;16:937–942.

    Article  PubMed  CAS  Google Scholar 

  62. Matte L, Sakamoto T, Greely GH, Thompson JC. Effect of substance P on contractions of the gallbladder. Surg Gynecol Obstet 1986;163:163–166.

    Google Scholar 

  63. Hildebrand P, Werth B, Beglinger C, et al. Human gastrin releasing peptide: biological potency in humans. Regul Peptides 1991;36:423–433.

    Article  CAS  Google Scholar 

  64. Kotwall CA, Clanachan AS, Baie HP. Effect of prostaglandins on motility of gallbladders removed from patients with gallstones. Arch Surg 1984;119:709–712.

    Article  PubMed  CAS  Google Scholar 

  65. McKirdy ML, McKirdy HC, Johnson CD. Non-adrenergic non-cholinergic inhibitory innervation shown by electric field stimulation of isolated strips of human gallbladder muscle. Gut 1994;35:412–46.

    Article  PubMed  CAS  Google Scholar 

  66. Pellegrini C, Ryan T, Broderick W, Way LW. Gallbladder filling and emptying during cholesterol gallstone formation in the prairie dog. Gastroenterology 1986;90: 143–149.

    PubMed  CAS  Google Scholar 

  67. Behar J, Lee KY, Thompson WR, et al. Gallbladder contraction in patients with pigment and cholesterol stones. Gastroenterology 1989;97:1479–1484.

    PubMed  CAS  Google Scholar 

  68. Tilvis RS, Aro J, Stranberg TE, et al. Lipid composition of bile and gallbladder mucosa in patients with acalculous cholesterolosis. Gastroenterology 1982;82:607–615.

    PubMed  CAS  Google Scholar 

  69. Yu PR, Chen Q, Biancani P, et al. Membrane cholesterol alters gallbladder muscle contractility in prairie dogs. Am J Physiol 1996;271:G56–61.

    PubMed  CAS  Google Scholar 

  70. Behar J, Rhim BY, Thompson WR, et al. Inositol triphosphate restores impaired human gallbladder motility associated with cholesterol stones. Gastroenterology 1993; 104:563–568.

    PubMed  CAS  Google Scholar 

  71. O’Donnell LJD, Fairclough PD. Gallstones and gallbladder motility. Gut 1993;34:440–443.

    Article  PubMed  Google Scholar 

  72. Jazrawi RP, Pazzi P, Petroni ML, et al. Postprandial gallbladder motor dysfunction: refilling and turnover of bile in health and cholelithiasis. Gastroenterology 1995;109: 582–591.

    Article  PubMed  CAS  Google Scholar 

  73. Shaffer EA, Lax H, Bomzon A, et al. Hydrophobic bile salts may directly impair gallbladder contractility to cholecystokinin. Gastroenterology 1990;98:A262.

    Google Scholar 

  74. Maringhini A, Ciambra M, Baccelliere P, et al. Biliary sludge and gallstones in pregnancy: incidence, risk factors, and natural history. Ann Intern Med 1993;119:116–120.

    Article  PubMed  CAS  Google Scholar 

  75. Messing B, Bories C, Kunstlinger F, et al. Does total parenteral nutrition induce gallbladder sludge formation and lithiasis? Gastroenterology 1983;84:1012–1019.

    PubMed  CAS  Google Scholar 

  76. Poston GJ, Singh P, Maclellan D, et al. Age related contractility and gallbladder cholecystokinin receptor population in the guinea pig. Mech Ageing Dev 1988;46: 225–236.

    Article  PubMed  CAS  Google Scholar 

  77. Poston GJ, Draviam EJ, Yao CZ, et al. Effect of age and sensitivity to cholecystokinin on gallstone formation in the guinea pig. Gastroenterology 1990;98:939–999.

    Article  Google Scholar 

  78. Khalil T, Walker PJ, Wiener I, et al. Effects of aging on gallbladder contraction and release of cholecystokinin-33 in humans. Surgery 1985;98:423–429.

    PubMed  CAS  Google Scholar 

  79. Berger D, Crowther RC, Floyd JC Jr, et al. Effect of age on fasting plasma levels of pancreatic hormones in man. Am J Surg 1978;47:1183–1189.

    CAS  Google Scholar 

  80. Moser AJ, Abedin MZ, Roslyn JJ. The pathogenesis of gallstone formation. Adv Surg 1993;26:357–386.

    PubMed  CAS  Google Scholar 

  81. Cahalane MJ, Neubrand MW, Carey MC. Physical-chemical pathogenesis of pigment stones. Semin Liver Dis 1988;8:317–328.

    Article  PubMed  CAS  Google Scholar 

  82. Trotman BW, Bernstein SE, Bove KE, et al. Studies on the pathogenesis of pigment gallstones in hemolytic anemia. J Clin Invest 1980;65:1301–1308.

    Article  PubMed  CAS  Google Scholar 

  83. Ostrow JD. The etiology of pigment gallstones. Hepatology 1984;4:215S-222S.

    Article  PubMed  CAS  Google Scholar 

  84. Carey MC. Pathogenesis of gallstones. Am J Surg 1993;165: 410–419.

    Article  PubMed  CAS  Google Scholar 

  85. Cetta F. The role of bacteria in pigment gallstone formation. Am Surg 1991;213:315–326.

    CAS  Google Scholar 

  86. Nagase M, Hikaro Y, Soloway RD, et al. Gallstones in western Japan: features affecting the prevalence of intrahepatic gallstones. Gastroenterology 1980;78:684–690.

    PubMed  CAS  Google Scholar 

  87. Ho KJ. Biliary electrolytes and enzymes in patients with and without gallstones. Dig Dis Sci 1996;41:2409–2416.

    Article  PubMed  CAS  Google Scholar 

  88. Apstein MD, Carey MC. Biliary tract stones and associated diseases. In: Stein JH (ed) Internal Medicine, 4th ed. St. Louis: Mosby Yearbook, 1993.

    Google Scholar 

  89. Cucchiaro G, Rossitch JC, Bowie J, et al. Clinical significance of ultrasonographically detected coincidental gallstones. Dig Dis Sci 1990;35:417–421.

    Article  PubMed  CAS  Google Scholar 

  90. Gibney EJ. Asymptomatic gallstones. Br J Surg 1990; 77:368–372.

    Article  PubMed  CAS  Google Scholar 

  91. Comfort MW, Gray HK, Wilson JM. The silent gallstone: a ten to twenty year follow-up study of 112 cases. Ann Surg 1948;128:931–937.

    Article  Google Scholar 

  92. Gracie WA, Ransohoff DF. The natural history of silent gallstones: the innocent gallstone is not a myth. N Engl J Med 1982;307:798–800.

    Article  PubMed  CAS  Google Scholar 

  93. Attili AF, DeSantis A, Capri R, Repice AM, Maselli S, GREPCO group. The natural history of gallstones: the GREPCO experience. Hepatology 1995;21:656–660.

    Article  Google Scholar 

  94. McSherry CK, Ferstenberg H, Calhoun WF, et al. The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients. Ann Surg 1985;202:59–63.

    Article  PubMed  CAS  Google Scholar 

  95. Friedman GD. Natural history of asymptomatic and symptomatic gallstones. Am J Surg 1993;165:399–404.

    Article  PubMed  CAS  Google Scholar 

  96. Fendrick AM, Gleeson SP, Cabana MD, Schwartz JS. Asymptomatic gallstones revisited: is there a role for laparoscopic cholecystectomy? Arch Fam Med 1993;2:959–968.

    Article  PubMed  CAS  Google Scholar 

  97. Wenckhert A, Robertson B. The natural course of gallstone disease. Gastroenterology 1966;50:376–381.

    Google Scholar 

  98. Cucchiaro G, Walters CR, Rossitch JC, et al. Deaths from gallstones: incidence and associated clinical factors. Ann Surg 1989;209:149–151.

    Article  PubMed  CAS  Google Scholar 

  99. Lieber MM. The incidence of gallstones and their correlation with other diseases. Ann Surg 1952;135:394–405.

    Article  PubMed  CAS  Google Scholar 

  100. Mundth ED. Cholecystitis and diabetes mellitus. N Engl J Med 1962;267:642–646.

    Article  PubMed  CAS  Google Scholar 

  101. Turill FL, McCarron MM, Mikkelsen WP. Gallstones and diabetics: an ominous association. Am J Surg 1961;102:184–190.

    Article  Google Scholar 

  102. Ransohoff DF, Miller GL, Forsythe SB, et al. Outcome of acute cholecystitis in patients with diabetes mellitus. Ann Intern Med 1987;106:829–832.

    Article  PubMed  CAS  Google Scholar 

  103. Friedman LS, Roberts MS, Brett AS, et al. Management of asymptomatic gallstones in the diabetic patient: a decision analysis. Ann Intern Med 1988;109:913–919.

    Article  PubMed  CAS  Google Scholar 

  104. Walsh DB, Eckhauser FE, Ramsburgh SR, Burney RB. Risks associated with diabetes mellitus in patients undergoing gallbladder surgery. Surgery 1982;91:254–257.

    PubMed  CAS  Google Scholar 

  105. Sandler RS, Maule WF, Baltus ME. Factors associated with postoperative complications in diabetics after biliary tract surgery. Gastroenterology 1986;91:157–162.

    PubMed  CAS  Google Scholar 

  106. Hjortrup A, Sorensen C, Dyremose E, et al. Influence of diabetes mellitus on operative risk. Br J Surg 1985;72:783–785.

    Article  PubMed  CAS  Google Scholar 

  107. Ikard RW. Gallstones, cholecystitis and diabetes. Surg Gynecol Obstet 1990;171:528–532.

    PubMed  CAS  Google Scholar 

  108. Del Favero G, Caroli A, Meggiato T, et al. Natural history of gallstones in non-insulin-dependent diabetes mellitus: a prospective 5 year follow-up. Dig Dis Sci 1994;39:1704–1707.

    Article  PubMed  Google Scholar 

  109. Schreiber H, Macon WL, Pories WJ. Incidental cholecystectomy during major abdominal surgery in the elderly. Am J Surg 1978;135:196.

    Article  PubMed  CAS  Google Scholar 

  110. Ouriel K, Ricotta JJ, Adams JT, et al. Management of cholelithiasis in patients with abdominal aortic aneurysm. Ann Surg 1983;198:717–719.

    Article  PubMed  CAS  Google Scholar 

  111. Green JD, Birkhead G, Herbert J, et al. Increased morbidity in surgical patients undergoing secondary (incidental) cholecystectomy. Ann Surg 1990;211:50–54.

    Article  PubMed  CAS  Google Scholar 

  112. Thistle JL, Cleary PA, Lachin JM, et al. The natural history of cholelithiasis: the National Cooperative Gallstone Study. Ann Intern Med 1984;101:171–175.

    Article  PubMed  CAS  Google Scholar 

  113. Friedman GD, Raviola CA, Fireman B. Prognosis of gallstones with mild or no symptoms: 25 years of follow-up in a health maintenance organization. J Clin Epidemiol 1989;42:127–136.

    Article  PubMed  CAS  Google Scholar 

  114. Ransohoff DF, Gracie WA. Treatment of gallstones. Ann Intern Med 1993;119:606–619.

    Article  PubMed  CAS  Google Scholar 

  115. Pigott JP, Williams GB. Cholecystectomy in the elderly. Am J Surg 1988;155:408–410.

    Article  PubMed  CAS  Google Scholar 

  116. Morrow DJ, Thompson J, Wilson SE. Acute cholecystitis in the elderly: a surgical emergency. Arch Surg 1978;113:1149–1152.

    Article  PubMed  CAS  Google Scholar 

  117. Diehl AK, Sugarek NJ, Todd KH. Clinical evaluation for gallstone disease: usefulness of symptoms and signs in diagnosis. Am J Med 1990;89:29–33.

    Article  PubMed  CAS  Google Scholar 

  118. Rigas B, Torosis J, McDougall CJ, et al. The circadian rhythm of biliary colic. J Clin Gastroenterol 1990;12:409–414.

    Article  PubMed  CAS  Google Scholar 

  119. Moscati RM. Cholelithiasis, cholecystitis, and pancreatitis. Emerg Med Clin North Am 1996;14:719–736.

    Article  PubMed  CAS  Google Scholar 

  120. Goldman DE, Gholson CF. Choledocholithiasis in patients with normal serum liver enzymes. Dig Dis Sci 1995;40: 1065–1068.

    Article  PubMed  CAS  Google Scholar 

  121. Zollinger RM. Observations following distension of the gallbladder and common duct in man. Proc Soc Expl Biol Med 1933;30:1260–1261.

    Article  Google Scholar 

  122. Fenster LF, Lonborg R, Thirlby RC, et al. What symptoms does cholecystectomy cure? Insights from an outcomes measurement project and review of the literature. Am J Surg 1995;169:535–538.

    Article  Google Scholar 

  123. Gilliland TM, Traverso W. Cholecystectomy provides long-term symptom relief in patients with acalculous cholecystitis. Am J Surg 1990;159:489–492.

    Article  PubMed  CAS  Google Scholar 

  124. Cobden I, Venables CW, Lendrum R, et al. Gallstones presenting as mental and physical disability in the elderly. Lancet 1984;(May 12): 1062–1064.

    Google Scholar 

  125. Zeman RK, Garra BS. Gallbladder imaging: the state of the art. Gastroenterol Clin North Am 1991;20:127–156.

    PubMed  CAS  Google Scholar 

  126. Jennings WC, Drabek GA, Miller KA. Significance of sludge and thickened wall in ultrasound evaluation of the gallbladder. Surg Gynecol Obstet 1992;174:394–398.

    PubMed  CAS  Google Scholar 

  127. Shlaer WJ, Leopold GR, Scheible FW. Sonography of the thickened gallbladder wall: a nonspecific finding. Am J Radiol 1981;136:337–339.

    CAS  Google Scholar 

  128. Shea JA, Berlin JA, Escarce JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med 1994;154:2573–2581.

    Article  PubMed  CAS  Google Scholar 

  129. Ros E, Valderrama R, Bru C, et al. Symptomatic versus silent gallstones: radiographic features and eligibility for nonsurgical treatment. Dig Dis Sci 1994;39:1697–1703.

    Article  PubMed  CAS  Google Scholar 

  130. Baron RL, Rohrmann CA, Lee SP, et al. CT evaluation of gallstones in vitro: correlation with chemical analysis. Am J Radiol 1988;151:1123–1128.

    CAS  Google Scholar 

  131. Tierneys, Pitt HA, Lillemoe KD. Physiology and Pathophysiology of gallbladder motility. Surg Clin Worth Am 1993;73:1267–1290.

    Google Scholar 

  132. Holzknecht N, Gauger J, Sackmann M, et al. Breath-hold MR cholangiography with snapshot techniques: prospective comparison with endoscopic retrograde cholangiography. Radiology 1998;206:657–664.

    PubMed  CAS  Google Scholar 

  133. Watkins JL, Blatt CF, Layden TJ. Gallstones: choosing the right therapy despite vague clinical cues. Geriatrics 1993; 48(8):48–54.

    PubMed  CAS  Google Scholar 

  134. Wetter LA, Way LW. Surgical therapy for gallstone disease. Gastroenterol Clin North Am 1991;20:157–169.

    PubMed  CAS  Google Scholar 

  135. Roslyn JJ, Binns GS, Hughes EFX, et al. Open cholecystectomy: a contemporary analysis of 42,474 patients. Ann Surg 1993;218:129–137.

    Article  PubMed  CAS  Google Scholar 

  136. Glenn F. The incidence and causes of death following surgery for nonmalignant biliary tract disease. Ann Surg 1980;191:271–275.

    Article  PubMed  Google Scholar 

  137. Margiotta SJ, Horwitz JR, Willis IH, et al. Cholecystectomy in the elderly. Am J Surg 1988;156:509–512.

    Article  PubMed  Google Scholar 

  138. Pigott JP, Williams GB. Choleystectomy in the elderly. Am J Surg 1988;155:408–410.

    Article  PubMed  CAS  Google Scholar 

  139. Escarce JJ, Shea JA, Chen W, et al. Outcomes of open cholecystectomy in the elderly: a longitudinal analysis of 21,000 cases in the prelaparoscopic era. Surgery 1995;117:156–164.

    Article  PubMed  CAS  Google Scholar 

  140. Morrow DJ, Thompson J, Wilson SE. Acute Cholecystitis in the elderly: a surgical emergency. Arch Surg 1978; 113–1149–1152.

    Google Scholar 

  141. Ransohoff DF, Gracie WA, Wolfenson LB, et al. Prophylactic cholecystectomy or expectant management for persons with silent gallstones: a decision analysis to assess survival. Ann Intern Med 1983;99:199–204.

    Article  PubMed  CAS  Google Scholar 

  142. Lygidakis NJ. Operative risk factors of cholecystectomy-choledochotomy in the elderly. Surg Gynecol Obstet 1983; 157:15–19.

    PubMed  CAS  Google Scholar 

  143. Gadacz TR, Talamini MA, Lillemoe KD, et al. Laparoscopic cholecystectomy. Surg Clin North Am 1990;70:1249–1262.

    PubMed  CAS  Google Scholar 

  144. Dubois F, Icard P, Barthelot G, et al. Coelioscopic cholecystectomy: preliminary report of 36 cases. Ann Surg 1990;211:60–62.

    Article  PubMed  CAS  Google Scholar 

  145. Reddick EJ, Olsen DO. Laparoscopic laser cholecystectomy: a comparison with mini-lap cholecystectomy. Surg Endosc 1989;3:131–133.

    Article  PubMed  CAS  Google Scholar 

  146. Orlando R, Russell JC, Mattie A, Connecticut Laparoscopic Cholecystectomy Registry. Laparoscopic cholecystectomy: a statewide experience. Arch Surg 1993;128:494–499.

    Article  PubMed  Google Scholar 

  147. Perissat J. Laparoscopic cholecystectomy: the European experience. Am J Surg 1993;165:444–449.

    Article  PubMed  CAS  Google Scholar 

  148. Soper NJ, Stockmann PT, Dunnegan DL, et al. Laparoscopic cholecystectomy: the new “gold standard”? Arch Surg 1992;127:917–921.

    Article  PubMed  CAS  Google Scholar 

  149. Bass EB, Pitt HA, Lillemoe KD. Cost-effectiveness of laparoscopic cholecystectomy versus open cholecystectomy. Am J Surg 1993;165:466–471.

    Article  PubMed  CAS  Google Scholar 

  150. McMahon AJ, Russell IT, Ramsay G, et al. Laparoscopic and minilaparotomy cholecystectomy: a randomized trial comparing postoperative pain and pulmonary function. Surgery 1994;115:533–539.

    PubMed  CAS  Google Scholar 

  151. Gadacz TR. U.S. experience with laparoscopic cholecystectomy. Am J Surg 1993;165:450–454.

    Article  PubMed  CAS  Google Scholar 

  152. Southern Surgeons Club. A prospective analysis of 1518 laparoscopic cholecystectomies. N Engl J Med 1991;324: 1073–1078.

    Article  Google Scholar 

  153. Deziel DJ, Milikan KW, Economou SG, et al. Complications of laparoscopic cholecystectomy: a national survey of 4292 hospitals and an analysis of 77,604 cases. Am J Surg 1996; 165:9–14.

    Article  Google Scholar 

  154. Nenner RP, Imperato PJ, Alcorn CM. Serious complications of laparoscopic cholecystectomy in New York State. NY State J Med 1992;92:179–181.

    CAS  Google Scholar 

  155. Southern Surgeons Club, Moore MJ, Bennett CL. The learning curve for laparoscopic cholecystectomy. Am J Surg 1995;170:55–59.

    Article  PubMed  CAS  Google Scholar 

  156. Williams LF, Chapman WC, Bonau RA, et al. Comparison of laparoscopic cholecystectomy with open cholecystectomy in a single center. Am J Surg 1993;165:459–465.

    Article  PubMed  Google Scholar 

  157. Lee VS, Chari RS, Cucchiaro G, et al. Complications of laparoscopic cholecystectomy. Am J Surg 1993;165:527–532.

    Article  PubMed  CAS  Google Scholar 

  158. Fried GM, Barkum JS, Sigman HH, et al. Factors determining conversion to laparotomy in patients undergoing laparoscopic cholecystectomy. Am J Surg 1994;167:35–41.

    Article  PubMed  CAS  Google Scholar 

  159. Massie MT, Massie LB, Marrangoni AG, et al. Advantages of laparoscopic cholecystectomy in the elderly and in patients with high ASA classifications. J Laparoendosc Surg 1993;3:467–476.

    Article  PubMed  CAS  Google Scholar 

  160. Fried GM, Clas D, Meakins JL. Minimally invasive surgery in the elderly patient. Surg Clin North Am 1994;74:375–387.

    PubMed  CAS  Google Scholar 

  161. Askew AR. Surgery for gallstones in the elderly. Aust NZ J Surg 1995;65:312–315.

    Article  CAS  Google Scholar 

  162. Ido K, Suzuki T, Kimura K, et al. Laparoscopic cholecystectomy in the elderly: analysis of pre-operative risk factors and postoperative complications. J Gastroenterol Hepatol 1995;10:517–522.

    Article  PubMed  CAS  Google Scholar 

  163. Milheiro A, Sousa FC, Oliveira L, et al. Pulmonary function after laparoscopic cholecystectomy in the elderly. Br J Surg 1996;83:1059–1061.

    Article  PubMed  CAS  Google Scholar 

  164. Soper NJ. Effect of nonbiliary problems on laparoscopic cholecystectomy. Am J Surg 1993;165:522–526.

    Article  PubMed  CAS  Google Scholar 

  165. Salen G, Tint GS, Shefer S. Treatment of cholesterol gallstones with litholytic bile acids. Gastroenterol Clin North Am 1991;20:171–181.

    PubMed  CAS  Google Scholar 

  166. Danzinger RG, Hofmann AF, Schoenfield LJ, et al. Dissolution of cholesterol gallstones by chenodeoxycholic acid. N Engl J Med 1972;286:1–8.

    Article  PubMed  CAS  Google Scholar 

  167. Bachrach WH, Hofmann AF. Ursodeoxycholic acid in the treatment of cholesterol lithiasis. Dig Dis Sci 1982;27:333–356.

    Article  Google Scholar 

  168. Salen G. Clinical perspective on the treatment of gallstones with ursodeoxycholic acid. J Clin Gastroenterol 1991;10: S12-S17.

    Google Scholar 

  169. Walker JW. The removal of gallstones by ether solution. Lancet 1891;1:874–875.

    Article  Google Scholar 

  170. Langenbuch C. Ein fall von exstirpation der gallenblase wegen chronischer cholelithiasis: Heilung. Berl Klin Wochenschr 1882;19:725–727.

    Google Scholar 

  171. Admirand WH, Way LW. Medical treatment of retained gallstones. Trans Assoc Am Phys 1972;85:382–387.

    PubMed  CAS  Google Scholar 

  172. Thistle JL, May GR, Bender CE, et al. Dissolution of cholesterol gallbladder stones by methyl tert-butyl ether administered by percutaneous transhepatic catheter. N Engl J Med 1989;320:633–635.

    Article  PubMed  CAS  Google Scholar 

  173. Pauletzki J, Holl J, Sackman M, et al. Gallstone recurrence after direct contact dissolution with methyltert-butyl ether. Dig Dis Sci 1995;40:1775–1781.

    Article  PubMed  CAS  Google Scholar 

  174. Albert MB, Fromm H, Borstelmann R, et al. Successful outpatient treatment of gallstones with piezoelectric lithotripsy. Ann Intern Med 1990;113:164–166.

    Article  PubMed  CAS  Google Scholar 

  175. Garcia G, Young HS. Biliary extracorporeal shock-wave lithotripsy. Gastroenterol Clin North Am 1991;20:201–207.

    PubMed  CAS  Google Scholar 

  176. Sackmann M, Ippisch E, Sauerbruch T, et al. Early gallstone recurrence rate after successful shock-wave therapy. Gastroenterology 1990;98:392–395.

    PubMed  CAS  Google Scholar 

  177. Bass EB, Steinberg EP, Pitt HA, et al. Cost-effectiveness of extracorporeal shock-wave lithotripsy versus cholecystectomy for symptomatic gallstones. Gastroenterology 1991;101:189–199.

    PubMed  CAS  Google Scholar 

  178. Svanvik J, Pellegrini CA, Allen B, et al. Transport of fluid and biliary lipids in the canine gallbladder in experimental cholecystitis. J Surg Res 1986;41:425–431.

    Article  PubMed  CAS  Google Scholar 

  179. Norman DC, Yoshikawa TT. Intraabdominal infections in the elderly. J Am Geriatr Soc 1983;31:677–684.

    PubMed  CAS  Google Scholar 

  180. Hanf A, Gutman M, Kaplan O, et al. The management of acute cholecystitis in elderly patients. Am Surg 1991;57: 648–652.

    Google Scholar 

  181. De Dombal FT. Acute abdominal pain in the elderly. J Clin Gastroenterol 1994;19:331–335.

    Article  PubMed  Google Scholar 

  182. Kim EE, Pjura G, Lowry P, et al. Morphine augmented cholescintigraphy in the diagnosis of acute cholecystitis. Am J Radiol 1986;147:1177–1179.

    CAS  Google Scholar 

  183. Margiotta SJ, Willis IH, Wallack MK. Cholecystectomy in the elderly. Am Surg 1988;54:34–39.

    PubMed  Google Scholar 

  184. Glenn F. Acute cholecystitis. Surg Gynecol Obstet 1976;143: 56–60.

    PubMed  CAS  Google Scholar 

  185. Ratner JT, Rosenberg CM. Management of gallstones in the aged. J Am Geriatr Soc 1975;23:258–264.

    PubMed  CAS  Google Scholar 

  186. Peters JH, Miller J, Nichols KE, et al. Laparoscopic cholecystectomy in patients admitted with acute biliary symptoms. Am J Surg 1993;166:300–303.

    Article  PubMed  CAS  Google Scholar 

  187. Zucker KA, Flowers JL, Bailey RW, et al. Laparoscopic management of acute cholecystitis. Am J Surg 1993;165: 508–514.

    Article  PubMed  CAS  Google Scholar 

  188. Flowers JA, Bailey RW, Graham SM, et al. Laparoscopic management of acute cholecystitis: the Baltimore experience. Am J Surg 1991;161:388–392.

    Article  PubMed  CAS  Google Scholar 

  189. Lo CM, Lai ECS, Fan ST, et al. Laparoscopic cholecystectomy for acute cholecystitis in the elderly. World J Surg 1996;20:983–987.

    Article  PubMed  CAS  Google Scholar 

  190. Glenn F. Surgical management of acute cholecystitis in patients of 65 years of age and older. Am J Surg 1981;193: 56–59.

    CAS  Google Scholar 

  191. Cohen SA, Siegel JH. Biliary tract emergencies: endoscopic and medical management. Crit Care Clin 1995;11:273–294.

    PubMed  CAS  Google Scholar 

  192. Kaufman M, Weissberg D, Schwartz I, et al. Cholecys-tostomy as a definitive operation. Surg Gynecol Obstet 1990;170:533–537.

    PubMed  CAS  Google Scholar 

  193. Goodachre B, van Sonnenberg E, D’Agostino H, et al. Interventional radiology in gallstone disease. Gastroenterol Clin North Am 1991;20:209–227.

    Google Scholar 

  194. Van Steenbergen W, Rigauts H, Ponette E, et al. Percutaneous cholecystostomy for acute complicated calculous cholecystitis in elderly patients. J Am Geriatr Soc 1993; 41:157–162.

    PubMed  Google Scholar 

  195. Browning PD, McGahan JP, Gerscovich EO. Percutaneous cholecystostomy for suspected acute cholecystitis in the hospitalized patient. J Vasc Int Radiol 1993;4:531–538.

    Article  CAS  Google Scholar 

  196. Hamy A, Visset J, Likholatnikov D, et al. Percutaneous cholecystostomy for acute cholecystitis in critically ill patients. Surgery 1997;121:398–401.

    Article  PubMed  CAS  Google Scholar 

  197. Feretis CB, Manouras AJ, Apostolidis NS, et al. Endoscopic transpapillary drainage of gallbladder empyema. Gastro-intest Endosc 1990;36:523–525.

    Article  CAS  Google Scholar 

  198. Strohl EL, Diffenbaugh WG, Baker JH, et al. Collective reviews: gangrene and perforation of the gallbladder. Int Abstr Surg 1962;114:1–7.

    Google Scholar 

  199. Felice PR, Trowbridge PE, Ferrara JJ. Evolving changes in the pathogenesis and treatment of the perforated gallbladder: a combined hospital study. Am J Surg 1984;149: 466–473.

    Article  Google Scholar 

  200. Niemeier OW. Acute free perforation of the gallbladder. Ann Surg 1934;99:922–924.

    PubMed  CAS  Google Scholar 

  201. Abu-Dalu J, Urca I. Acute cholecystitis with perforation into the peritoneal cavity. Arch Surg 1971;102:108–111.

    Article  PubMed  CAS  Google Scholar 

  202. Roslyn JJ, Busutill RW. Perforation of the gallbladder: a frequently mismanaged condition. Am J Surg 1979;137: 307–312.

    Article  PubMed  CAS  Google Scholar 

  203. Madrazo BL, Francis I, Hricak H, et al. Sonographic findings in perforation of the gallbladder. AJR 1982;139:491–496.

    Article  PubMed  CAS  Google Scholar 

  204. Roslyn JJ, Thompson JE Jr, Darvin H, et al. Risk factors for gallbladder perforation. Am J Gastroenterol 1987;82:636–640.

    PubMed  CAS  Google Scholar 

  205. Cooperman AM, Dickson ER, ReMine WH. Changing concepts in the surgical treatment of gallstone ileus. Ann Surg 1968;167:377–383.

    Article  PubMed  CAS  Google Scholar 

  206. Siskind BN, Hawkins HB, Cinti DC, et al. Gallbladder perforation: an imaging analysis. J Clin Gastroenterol 1987; 9:670–678.

    Article  PubMed  CAS  Google Scholar 

  207. Soiva M, Pamilo M, Paivansalo M, et al. Ultrasonography in acute gallbladder perforation. Acta Radiol 1988;29:41–44.

    PubMed  CAS  Google Scholar 

  208. Kim PN, Lee KS, Kim IY, et al. Gallbladder perforation: comparison of US findings with CT. Abdom Imaging 1994;19:239–242.

    Article  PubMed  CAS  Google Scholar 

  209. Simmons TC, Miller C, Weaver R. Spontaneous gallbladder perforation. Am Surg 1989;55:311–313.

    PubMed  CAS  Google Scholar 

  210. Heuman R, Sjodahl R, Wetterfors J. Gallstone ileus: an analysis of 20 patients. World J Surg 1980;4:595–600.

    Article  PubMed  CAS  Google Scholar 

  211. Andreu J, Perez C, Caceres J, et al. Computed tomography as the method of choice in the diagnosis of emphysematous cholecystitis. Gastrointest Radiol 1987;12:315–318.

    Article  PubMed  CAS  Google Scholar 

  212. Mentzer RM, Golden GT, Chandler JG, et al. A comparative appraisal of emphysematous cholecystitis. Am J Surg 1975;129:10–15.

    Article  PubMed  Google Scholar 

  213. Yeatman TJ. Emphysematous cholecystitis: an insidious variant of acute cholecystitis. Am J Emerg Med 1986;4: 163–166.

    Article  PubMed  CAS  Google Scholar 

  214. Jolly BT, Love JN. Emphysematous cholecystitis in an elderly woman: case report and review of the literature. J Emerg Med 1993;11:593–597.

    Article  PubMed  CAS  Google Scholar 

  215. Jacob H, Appelman R, Stein HD. Emphysematous cholecystitis. Am Coll Gastroenterol 1979;71:325–330.

    CAS  Google Scholar 

  216. Parulekar SG. Sonographic findings in acute emphsema-tous cholecystitis. Radiology 1982;145:117–119.

    PubMed  CAS  Google Scholar 

  217. Banwell PE, Hill ADK, Menzies-Gow N, et al. Laparoscopic cholecystectomy: safe and feasible in emphysematous cholecystitis. Surg Laparosc Endosc 1994; 4:189–191.

    PubMed  CAS  Google Scholar 

  218. Csendes A, Burdiles P, Maluenda F, et al. Simultaneous bacteriologic assessment of bile from gallbladder and common bile duct in control subjects and patients with gallstones and common duct stones. Arch Surg 1996;131:389–394.

    Article  PubMed  CAS  Google Scholar 

  219. Bernhoft RA, Pelligrini CA, Moston RW, et al. Composition and morphologic and clinical features of common duct stones. Am J Surg 1984;148:77–79.

    Article  PubMed  CAS  Google Scholar 

  220. Anciaux ML, Pelletier G, Attali P, et al. Prospective study of clinical and biochemical features of symptomatic choledocholithiasis. Dig Dis Sci 1986;31:449–451.

    Article  PubMed  CAS  Google Scholar 

  221. Hauer-Jensen M, Karesen R, Nygaard K, et al. Prospective randomized study of routine intraoperative cholangiography during open cholecystectomy: long-term follow-up and predictors of choledocholithiasis. Surgery 1993;113: 318–323.

    PubMed  CAS  Google Scholar 

  222. Hunguier M, Bornet P, Charpak Y, et al. Selective contraindication based on multivariate analysis for operative cholangiography in biliary lithiasis. Surg Gynecol Obstet 1991;172:470–474.

    Google Scholar 

  223. Cronan JJ. US diagnosis of choledocholithiasis: a reappraisal. Radiology 1986;161:133–134.

    PubMed  CAS  Google Scholar 

  224. Phillips EH. Routine versus selective intraoperative cholangiography. Am J Surg 1993;165:505–507.

    Article  PubMed  CAS  Google Scholar 

  225. Perissat J, Huibregtse K, Keane FBV, et al. Management of bile duct stones in the era of laparoscopic cholecystectomy. Br J Surg 1994;81:799–810.

    Article  PubMed  CAS  Google Scholar 

  226. Boulay J, Schellenberg R, Brady PG. Role of ERCP and therapeutic biliary endoscopy in association with laparoscopic cholecystectomy. Am J Gastroenterol 1992;87:837–842.

    PubMed  CAS  Google Scholar 

  227. Lai ECS, Mok FPT, Tan ESY, et al. Endoscopic biliary drainage for severe acute cholangitis. N Engl J Med 1992;326:1582–1586.

    Article  PubMed  CAS  Google Scholar 

  228. Fan ST, Lai ECS, Mok FPT, et al. Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med 1993;328:228–232.

    Article  PubMed  CAS  Google Scholar 

  229. Lezoche E, Paganini AM, Carlei F, et al. Laparoscopic treatment of gallbladder and common bile duct stones: a prospective study. World J Surg 1996;20:535–542.

    Article  PubMed  CAS  Google Scholar 

  230. Vaira D, D’Anna L, Ainley C, et al. Endoscopic sphincterotomy in 1000 consecutive patients. Lancet 1989;2: 431–434.

    Article  PubMed  CAS  Google Scholar 

  231. Sherman S, Ruffolo TA, Hawes RH, et al. Complications of endoscopic sphincterotomy: a prospective series with emphasis on the increased risk associated with sphincter of Oddi dysfunction and nondilated bile ducts. Gastroenterology 1991;101:1068–1075.

    PubMed  CAS  Google Scholar 

  232. Pitt HA. Role of open choledochotomy in the treatment of choledocholithiasis. Am J Surg 1993;165:483–486.

    Article  PubMed  CAS  Google Scholar 

  233. Moston RW, Wetter LA. Operative choledochoscopy: common bile duct exploration is incomplete without it. Br J Surg 1990;77:975–979.

    Article  Google Scholar 

  234. Phillips EH. Routine versus selective intraoperative cholangiography. Am J Surg 1993;165:505–507.

    Article  PubMed  CAS  Google Scholar 

  235. Burhenne HJ. Percutaneous extraction of retained biliary tract stones: 661 patients. Am J Radiol 1980;134: 888–891.

    Google Scholar 

  236. Levine SB, Lerner SJ, Leifer ED, et al. Intraoperative cholangiography: a review of indications and analysis of age-sex groups. Ann Surg 1983;198:692–697.

    Article  PubMed  CAS  Google Scholar 

  237. Petelin JB. Laparoscopic approach to common duct pathology. Ann J Surg 1993;165:487–491.

    Article  CAS  Google Scholar 

  238. May GR, Shaffer EH. Should elective endoscopic sphincterotomy replace cholecystectomy for the treatment of high-risk patients with gallstone pancreatitis? J Clin Gastroenterol 1991;13:125–128.

    Article  PubMed  CAS  Google Scholar 

  239. Siegel JH, Safrany L, Ben-Zvi JS, et al. Duodenoscopic sphincterotomy in patients with gallbladders in situ: report of a series of 1272 patients. Am J Gastroenterol 1998; 83:1255–1258.

    Google Scholar 

  240. Himal HS. Role of endoscopic sphincterotomy alone in patients with choledocholithiasis and cholelithiasis. Can J Surg 1996;39:225–228.

    PubMed  CAS  Google Scholar 

  241. Adamek HE, Maier M, Jakobs R, et al. Management of retained bile duct stones: a prospective open trial comparing extracorporeal and intracorporeal lithotripsy. Gastrointest Endosc 1996;44:40–47.

    Article  PubMed  CAS  Google Scholar 

  242. Bergman JJGHM, Rauws EAJ, Tijssen JGP, et al. Biliary endoprostheses in elderly patients with endoscopically irretrievable common bile duct stones: report on 117 patients. Gastrointest Endosc 1995;42:195–201.

    Article  PubMed  CAS  Google Scholar 

  243. Palmer KR, Hofmann AF. Intraductal mono-octanoin for the direct dissolution of bile duct stones: experience in 343 patients. Gut 1986;27:196–200.

    Article  PubMed  CAS  Google Scholar 

  244. Cairns SR, Dias L, Cotton PB, et al. Additional endoscopie procedures instead of urgent surgery for retained common bile duct stones. Gut 1989;30:535–540.

    Article  PubMed  CAS  Google Scholar 

  245. Deenitchin GP, Konomi H, Kimura H, et al. Reappraisal of safety of endoscopic sphincterotomy for common bile duct stones in the elderly. Am J Surg 1995;170:51–54.

    Article  PubMed  CAS  Google Scholar 

  246. Hammarstrom LE, Holmin T, Stridbeck H, et al. Long-term follow-up of prospective randomized study of endoscopic versus surgical treatment of bile duct calculi in patients with gallbladder in situ. Br J Surg 1995;82:1516–1521.

    Article  PubMed  CAS  Google Scholar 

  247. Jones DB, Soper NJ, Brewer JD, et al. Chronic acalculous cholecystitis: laparoscopic treatment. Surg Laparosc Endosc 1996;6:114–122.

    Article  PubMed  CAS  Google Scholar 

  248. Barron LG, Rubio PA. Importance of accurate preoperative diagnosis and role of advanced laparoscopic cholecystectomy in relieving chronic acalculous cholecystitis. J Laparoendosc Surg 1995;5:357–361.

    Article  PubMed  CAS  Google Scholar 

  249. Gilliland TM, Traverso LW. Cholecystectomy provides long-term symptom relief in patients with acalculous gallbladders. Am J Surg 1990;159:489–492.

    Article  PubMed  CAS  Google Scholar 

  250. Raunest J, Imhof M, Rauen U, et al. Acute choecystitis: a complication in severely injured intensive care patients. J Trauma 1992;32:443–440.

    Article  Google Scholar 

  251. Savoca P, Longo W, Zucker K, et al. The increasing prevalence of acalculous cholecystitis in outpatients: results of a 7-year study. Ann Surg 1990;211:433–437.

    Article  PubMed  CAS  Google Scholar 

  252. Peterson SR, Sheldon GR Acute acalculous cholecystitis: a complication of hyperalimentation. Arch Surg 1984;119: 1389–1392.

    Article  Google Scholar 

  253. Kavin H, Jonas RB, Chowdury L, et al. Acalculous cholecystitis and cytomegalovirus infection in the acquired immunodeficiency syndrome. Ann Intern Med 1986;104: 53–54.

    Article  PubMed  CAS  Google Scholar 

  254. Scher KS, Sarap D, Jaggers RL. Acute acalculous cholecystitis complicating aortic aneurysm repair. Surg Gynecol Obstet 1986;163:475–478.

    PubMed  CAS  Google Scholar 

  255. Barie PS, Fischer E. Acute acalculous cholecystitis. J Am Coll Surg 1995;180:232–244.

    PubMed  CAS  Google Scholar 

  256. Orlando R, Gleason E, Drezner AD. Acute acalculous cholecystitis in the critically ill patient. Am J Surg 1983; 145:472–176.

    Article  PubMed  Google Scholar 

  257. Niderheiser DH. Acute acalculous cholecystitis induced by lysophosphatidyl choline. Am J Pathol 1986;124:559–563.

    Google Scholar 

  258. Taoka H. Experimental study on the pathogenesis of acute acalculous cholecystitis, with special reference to the roles of microcirculatory disturbances, free radicals and membrane-bound phospholipase A2. Gastroenterol Jpn 1991;26:633–644.

    PubMed  CAS  Google Scholar 

  259. Becker CG, Dubin T, Glenn F. Induction of acute cholecystitis by activation of factor XII. J Exp Med 1980;151:81–90.

    Article  PubMed  CAS  Google Scholar 

  260. Shapiro MJ, Luchtefeld WB, Kurzweil S, et al. Acute acalculous cholecystitis in the critically ill. Am Surg 1994; 60:335–339.

    PubMed  CAS  Google Scholar 

  261. Schneider PB. Acalculous cholecystitis: a case with variable cholescintigram. J Nucl Med 1984;25:64–65.

    PubMed  CAS  Google Scholar 

  262. Shuman WP, Roger JV, Rudd TG, et al. Low sensitivity of sonography and cholescintigraphy in acalculous cholecystitis. Am J Radiol 1984;142:531–534.

    CAS  Google Scholar 

  263. Deitch EA, Engel JM. Ultrasound in elective biliary tract surgery. Am J Surg 1988;140:277–283.

    Article  Google Scholar 

  264. Becker CD, Burckhardt B, Terrier F. Ultrasound in postoperative acalculous cholecystitis. Gastrointest Radiol 1986; 11:47–50.

    Article  PubMed  CAS  Google Scholar 

  265. Cornwell EEI, Rodriguez A, Mirvis SE, et al. Acute acalculous cholecystitis in critically injured patients: preoperative diagnostic imaging. Ann Surg 1989;210:52–55.

    Article  PubMed  Google Scholar 

  266. Glenn F, Becker CG. Acute acalculous cholecystitis: an increasing entity. Ann Surg 1982;195:131–136.

    Article  PubMed  CAS  Google Scholar 

  267. Flancbaum L, Majerus TC, Cox EF. Acute posttraumatic acalculous cholecystitis. Am J Surg 1985;150:252–256.

    Article  PubMed  CAS  Google Scholar 

  268. Melin MM, Sarr MG, Bender CE, et al. Percutaneous cholecystostomy: a valuable technique in high-risk patients with presumed acute cholecystitis. Br J Surg 1995; 82:1274–1277.

    Article  PubMed  CAS  Google Scholar 

  269. Vauthey JN, Lerut J, Martini M, et al. Indications and limitations of percutaneous cholecystectomy for acute cholecystitis. Surg Gynecol Obstet 1993;176:49–54.

    PubMed  CAS  Google Scholar 

  270. Van Sonnenberg E, D’Agostino HB, Goodachre BW, et al. Percutaneous gallbladder puncture and cholecystostomy: results, complications, and caveats for safety. Radiology 1992;183:167–170.

    Google Scholar 

  271. Johlin FC, Neil GA. Drainage of the gallbladder in patients with acute acalculous cholecystitis by transpapillary endoscopic cholecystostomy. Gastrointest Endosc 1993;39: 645–651.

    Article  PubMed  Google Scholar 

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Authors
  1. Kim U. Kahng
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Editors and Affiliations

  1. Department of Surgery, Yale University School of Medicine, New Haven, CT, 06520, USA

    Ronnie A. Rosenthal MD (Associate Professor, Chief, Surgical Service) (Associate Professor, Chief, Surgical Service)

  2. Department of Veterans Affairs, VA Connecticut Healthcare System, West Haven, 06516, CT, USA

    Ronnie A. Rosenthal MD (Associate Professor, Chief, Surgical Service) (Associate Professor, Chief, Surgical Service)

  3. Department of Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, 10461, NY, USA

    Michael E. Zenilman MD (Associate Professor and Vice-Chairman, Chief of Surgery) (Associate Professor and Vice-Chairman, Chief of Surgery)

  4. Jack D. Weiler Hospital of the Albert Einstein College of Medicine, Bronx, 10461, NY, USA

    Michael E. Zenilman MD (Associate Professor and Vice-Chairman, Chief of Surgery) (Associate Professor and Vice-Chairman, Chief of Surgery)

  5. Wyoming Valley Surgical Associates, Kingston, 18704, PA, USA

    Mark R. Katlic M.D. (Chief of Thoracic Surgery) (Chief of Thoracic Surgery)

  6. Wyoming Valley Healthcare System, Wilkes-Barre, 18702, PA, USA

    Mark R. Katlic M.D. (Chief of Thoracic Surgery) (Chief of Thoracic Surgery)

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© 2001 Springer Science+Business Media New York

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Kahng, K.U., Wargo, J.A. (2001). Gallstone Disease in the Elderly. In: Rosenthal, R.A., Zenilman, M.E., Katlic, M.R. (eds) Principles and Practice of Geriatric Surgery. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-3432-4_49

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  • DOI: https://doi.org/10.1007/978-1-4757-3432-4_49

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4757-3434-8

  • Online ISBN: 978-1-4757-3432-4

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