Classificazione dei calcoli biliari e implicazioni clinico-terapeutiche



Ann. Ital. Chir., LXIX, 6, 1998

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A new classiffcation of gallstones is reported, which has interesting
implications for diagnostic and therapeutic purposes.
Gallstones heve been divided according to “type” into the
following cathegories: cholesterol (single, multiple), mixed,
black pigment, brown pigment, combination and composite.
In addition, gallstones primarily formed within the gallbladder
have been distinguished from those initially formed
in the common duct (before and after surgery) and within
the intrahepatic ducts. Stone type and composition have
been related to symptoms, on the basis of a new view, according
to which gallstones are not a unique entity, but a
heterogeneous disease including different entities, each of
which has its own pathogenesis, clinical manifestations, biological
behaviour and also deserves a different treatment.
The proper treatment should be appropriate to the individual
and his stones.
Therapeutic guide-lines are suggested for each type of stones,
in particular for stones complicated by cholangitis, pancreatitis,
or for common duct stones concomitantly found
with gallbladder stones. For the last group, techniques and
therapeutic options preserving the function of the sphincter
of Oddi are recommended. Suggestions are also reported concerning
the treatment of various types of hepatolithiasis:
primary, i.e. associated with cystics intrahepatic bile duct
dilatation; post-surgical, i.e. occurring cranially to a biliary
enteric anastomosis; secondary, i.e. associated with concomitant
gallbladder and common duct stones.


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