CHANGE AND ACCEPTANCE OF SURGICAL AND NONINVASIVE MANAGEMENT OF GALLBLADDER STONES

Background: The treatment of cholecystolithiasis has changed fundament ally in recent years due to the development of non-surgical techniques (extracorporeal shockwave lithotropsy [ESWL], oral litholysis) and th e implementation of laparoscopic cholecystectomy. Patients and Results : Retrospective analysis of 2270 patients (1649 women, 62 men; age: 47 .2 +/- 14 years) presenting with gallstone disorders in a university m edical outpatients department between 1988 and 1992 in order to be ins tructed as to the most suitable therapy method bear witness to the rap id change in therapeutic procedure. Laparoscopic removal of the gallbl adder has virtually supplanted conventional cholecystectomy, and withi n 5 years the proportionate role of ESWL has declined from 21 to 12%. Over the years, the proportion of patients requiring no therapeutic in tervention remained constant (at about 20%). the therapeutic recommend ations of the ''experts'' were implemented in almost 80% of cases. The majority of patients were satisfied with the chosen therapeutic appro ach (surgery: 93.0%, ESWL: 77.6%), although 44% of ESWL-patients and 3 6% of surgically managed patients reported complaints which persisted even after completion of therapy. Despite unsuccessful ESWL (residual fragments or recurrent stones) 58795 (61%) of interviewed patients wou ld again give preference to this non-invasive modality in the event of a renewed therapeutic decision. Conclusion: Only a few years after it s introduction, laparoscopic cholecystectomy has asserted itself as th e predominant treatment option. But as fas as acceptance and preferenc e by the patient are concerned extracorporeal shockwave lithotropsy - as a non-invasive treatment modality - also enjoys high popularity and can be recommended as an alternative to surgery in suitable patients chosen according to the currently established stringent selection crit eria.