Education And Debate

Fortnightly Review: The treatment of gall stones

BMJ 1995; 311 doi: https://doi.org/10.1136/bmj.311.6997.99 (Published 08 July 1995) Cite this as: BMJ 1995;311:99
  1. N Tait, senior lecturera,
  2. J M Little, professora
  1. aUniversity of Sydney Department of Surgery, Westmead Hospital, Westmead, New South Wales, Australia 2145
  1. Correspondence to: Mr Tait.

    Summary points

    • Gall stones are the commonest digestive cause of hospital admission in Western societies

    • Upper abdominal pain is the commonest presenting symptom and abdominal ultrasound scanning the most cost effective diagnostic tool

    • The principles of treatment and patient selec- tion have not been changed by laparoscopic surgery

    • Asymptomatic gall stones uncommonly warrant intervention

    • Symptomatic gall stones are best treated by removal of the stones and by elimination of the risk of recurrence

    History

    Alexander of Tralles (525-605), a physician of the Byzantine Empire, left the earliest known writings on gall stones, describing calculi in human livers.1 Our oldest physical evidence of human gall stones--30 stones in the intact gall bladder of a mummified Egyptian priestess from around 1500 BC2--was lost when the museum of the Royal College of Surgeons in London was bombed during the second world war.

    A multiplicity of non-surgical treatments have been used, including prayer, magic, the application of poultices and pigeons, phlebotomy, ingestion of herbs and potions, and attempts at gall stone dissolution. Most would now fall outside those approved by the mianstream of modern medicine. Francis Glisson (1597-1677) described the capsule of the liver but also experimented with dietary remedies for his own gall stones. Orgardney described in vitro dissolution of gall stones with turpentine but refrained from trying it in patients. Gall stone dissolution, though now much more effective than it was, is still associated with high failure and recurrence rates and is used in only a small proportion of cases.

    The history of surgery for gall stones is fairly short. Cholecystotomy was reported and recommended by Jean-Louis Petit in 1743 after he had mistakenly opened the gall bladder when attempting to drain what he thought was an abdominal wall abscess.3 Adhesions between the gall bladder and the abdominal wall prevented leakage …

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