| Abstract: |
The treatment of gallstones (cholelithiasis) without surgery has long been a goal of medical therapy. This chapter on the nonsurgical management of gallstone disease is from a comprehensive and authoritative textbook that covers disorders of the gastrointestinal tract, biliary tree, pancreas, and liver, as well as the related topics of nutrition and peritoneal disorders. Topics include general aspects; oral bile acid dissolution therapy, including pathophysiologic considerations and rationale, therapeutic regimens, patient selection, efficacy, safety, and side effects; extracorporeal shock wave lithotripsy (ESWL), including background and rationale, physical and technical aspects of shock waves, procedure, patient selection, efficacy, safety, and side effects; ESWL used for bile duct stones, including the procedure, patient selection, efficacy, safety, and side effects; recurrence of gallstones; and choice of treatment. The author stresses that nonsurgical approaches represent a long term solution only for patients in whom the disturbance that led to the formation of gallstones is transient. Gallstones recur within approximately five years in 30 to 50 percent of the patients whose stones are eliminated nonsurgically. The chapter includes a mini-outline with page citations, full-color illustrations, and extensive references. 3 figures. 3 tables. 58 references. |