General Surgery pp 1053-1060 | Cite as


  • Luis A. Ibañez
  • Jean M. Butte
  • Nicolás A. Devaud
Reference work entry

Pearls and Pitfalls

  • Cholelithiasis is asymptomatic in most patients.

  • Abdominal ultrasonography is currently the best diagnostic tool, with a 95% sensitivity for gallstones.

  • The presence of associated bile duct stones (choledocholithiasis) should be suspected through clinical signs such as jaundice and dark urine (bilirubinuria), together with radiologic and laboratory findings, such as bile duct dilation or increases in serum bilirubin concentration, alkaline phosphatase activity, or aspartate transaminase activity.

  • In patients with a high suspicion of choledocholithiasis, MR cholangio-pancreatography (MRCP) provides a non-invasive, highly sensitive, diagnostic alternative.

  • Most patients with asymptomatic cholelithiasis do not require cholecystectomy.

  • Among symptomatic patients, laparoscopic cholecystectomy is the treatment of choice.

  • Cholelithiasis is a major risk factor for gallbladder cancer.


Cholelithiasis is the presence of stones in the gallbladder. Gallstones in...


Laparoscopic Cholecystectomy Cystic Duct Acute Cholecystitis Gallbladder Cancer Common Bile Duct Stone 
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Selected Readings

  1. Berger M, Van der Velden J, Lijmer J, et al. (2000) Abdominal symptoms: do they predict gallstones? A systematic review. Scand J Gastroenterol 35:70–76PubMedCrossRefGoogle Scholar
  2. Ji W, Li L, Wang Z, et al. (2005) A randomized controlled trial of laparoscopic versus open cholecystectomy in patients with cirrhotic portal hypertension. World J Gastroenterol 11:2513–2517PubMedGoogle Scholar
  3. Lu E, Curet M, El-Sayed Y, Kirkwood K, (2004) Medical versus surgical management of biliary tract disease in pregnancy. Am J Surg 188:755–759PubMedCrossRefGoogle Scholar
  4. Miquel JF, Covarrubias C, Villarroel L, et al. (1998) Genetic epidemiology of cholesterol cholelithiasis among Chilean Hispanic, Amerindians and Maoris. Gastroenterology 115:937–946PubMedCrossRefGoogle Scholar
  5. Nakeeb A, Comuzzie A, Martin L, et al. (2002) Gallstones: genetics versus environment. Ann Surg 235:842–849PubMedCrossRefGoogle Scholar
  6. Nathanson LK, O'Rourke NA, Martin IJ, et al. (2005) Postoperative ERCP versus laparoscopic choledocotomy for clearance of selected bile duct calculi: a randomized trial. Ann Surg 242:188–192PubMedCrossRefGoogle Scholar
  7. Stephen AE, Berger DL, (2001) Carcinoma in the porcelain gallbladder: a relationship revisited. Surgery 129:699–703PubMedCrossRefGoogle Scholar
  8. Yeh C, Chen M, Jan Y, (2002) Laparoscopic cholecystectomy in 226 cirrhotic patients. Experience of a single center in Taiwan. Surg Endosc 16:1583–1587PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Luis A. Ibañez
    • 1
  • Jean M. Butte
  • Nicolás A. Devaud
  1. 1.Digestive Surgery Department División de CirugíaPontificia Universidad Católica de ChileMarcoleta 367Chile

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