The Spectrum and Cost of Complicated Gallstone Disease in California

Abstract

GALLSTONE DISEASE is a common problem in the United States. Approximately 10% of the population in Western societies have gallstones, with a 5-year incidence of 2% to 4%.^1-3 In the United States, about 600,000 cholecystectomies are performed annually for symptomatic gallstone disease, making this one of the most common abdominal operations performed. Longitudinal studies show that most patients with gallstones are asymptomatic and remain so, with fewer than 20% of the patients requiring surgery for biliary colic or gallstone-related complications during a 20-year follow-up period.^4,5 Decision analyses support an expectant, nonoperative approach in most patients with asymptomatic gallstones.^6,7 In contrast, most patients with symptomatic gallstones remain symptomatic and it is estimated that 1% to 3% per year develop complications of their gallstones, such as acute cholecystitis.⁸ Based on these observations, cholecystectomy has been widely advocated for patients with symptomatic gallstones.