RECENT ADVANCES IN THE MANAGEMENT OF GALLSTONES

Demands for less invasive, more cost-effective therapy have revolution ized the management of gallstones over the past 10 years. There are no reliable methods of permanently reversing the pathophysiologic defect s that cause gallstones. Open cholecystectomy (OC), the gold standard for managing symptomatic cholelithiasis, has been largely replaced by laparoscopic cholecystectomy (LC), which has the advantages of a minim al hospital stay and quicker return to work. Other adjunctive therapie s, limited in applicability to selected patients, include oral bile ac id therapy (BAT), dissolutional agents, and extracorporeal shock wave lithotripsy. Choledocholithiasis (CDL), formerly managed exclusively w ith surgical common duct exploration, is increasingly treated with the rapeutic biliary endoscopy. Methods of laparoscopic common bile duct e xploration are being developed. Optimal algorithms for applying these techniques to patients undergoing LC are evolving. In a sense, the sol ution to all, or certainly most, gallstones now can be seen through a scope.