Colecistectomia profilattica per calcolosi della colecisti

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G. P. SPINA, M. PAGANI

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

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Asymptomatic gallstones are defined as stones that have not
caused biliary colics or other biliary symptons. Some crosssectional
epidemiological screening studies have shown that
as many as 66% to 77% of patiens with gallstones are
asymptomatic. Studies of natural history suggest that the
cumulative probability of devoloping biliary colics after ten
years ranges from 15% to 25%. None of the variables considered
as possible modifiers of natural history, were found
to be associated with an increased risk of incidence of biliary
colics. Cholecystectomy is a vary safe treatment and is being
performed with near zero mortality. Two are the possible
strategies compared: prophylactic cholecystectomy with expectant
management for silent gallstone disease. Consideration
of survival and monetary costs disfavors prophylactic cholecystectomy.
The results of laparoscopic cholecystectomy compare
favorably with those of open cholecystectomy with
respect to mortality, complications, length of hospital stay,
cosmetically satisfactory and financial benefits. Patients with
asymptomatic stones in the gallbladder require neither surgical
nor medical treatment. Consideration of monetary costs
disfavors prophylactic cholecystectomy: a waiting attitude has
the advantage of lowering the sanitary costs also for the
high incidence of silent gallstones in our population.

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