TREATING GALL-STONES

Widespread use of echography and laparoscopic surgery has caused a rev olution in the treatment of gall stones. The question now is which pat ients should be treated, and when and how? One clear answer concerns a symptomatic cases: no one. The only patients which might benefit from ''prophylactic cholecystectomy'' are potential graft recipients, altho ugh no evaluation has been performed. For cholesterol stones, drugs ca n be effective if the bladder functions correctly. Their effect can so metimes be accelerated with extracorporal lithotripsy. The indications of intracorporal lithotripsy are limited by the risks involved. But t he big breakthough came with laparoscopic procedures, now performed by nearly all surgeons because of the major improvements in patient comf ort. This new technique reduces abdominal pain and scar tissue formati on with the subsequent gain in hospitalization time. In the very near future, laparoscopic cholecystectomy will undoubtedly be considered th e reference surgical technique, although until the question of systema tic peroperative opacification of the main bile duct has been totally solved, traditional laparotomy will continue to have first intention i ndications.