Gallstones

Abstract

#### Summary points About 10-15% of the adult Western population will develop gallstones, with between 1% and 4% a year developing symptoms.1 From April 2005 to March 2006, 49 077 cholecystectomy procedures took place in England,2 a 10th of the number of procedures in the United States.3 The management of gallstone disease is changing rapidly, with an increase in day case surgery and in cholecystectomy during the index admission for cholecystitis and with the advent of natural orifice transluminal endoscopic surgery. This review focuses on the problems that gallstones cause and their optimal treatment based on current evidence. Gallstones occur when there is an imbalance in the chemical constituents of bile that results in precipitation of one or more of the components. Why this occurs is unclear, although certain risk factors are known. Gallstones are seen in all age groups but the incidence increases with age.4 The old adage “fat and fertile, female and forty” tells only part of the story. Oestrogen does cause more cholesterol to be excreted into bile, and obesity (body mass index >30) is …