GALLBLADDER MOTILITY, GALLSTONES, AND THE SURGEON

Cholecystectomy is one of the commonest surgical procedures in the Wes tern world, with more than half a million procedures performed annuall y in the United States alone. In recent years, studies of gallstone pa thogenesis and gallbladder disease have increasingly focused on abnorm al gallbladder motility in the pathogenesis of some, if not all, gallb ladder conditions. The control of gallbladder motility is complex and depends on an intricate interplay of neural and hormonal factors. An u nderstanding of the control of gallbladder motility is crucial to the understanding of the mechanisms of gallstone formation and may help to explain the failure to cure symptoms after cholecystectomy in up to o ne third of patients. The purpose of this article is to outline mechan isms controlling gallbladder motility, examine recent developments in our understanding of this complex process, and relate changes in motil ity to common disease conditions of the gallbladder. The role of alter ed motility in the pathogenesis of gallstones is discussed and the eff ects of commonly performed surgical procedures such as truncal vagotom y and cholecystectomy on upper gut physiology are reviewed.