Gallstones: Physiopathology and treatment of cholelithiasis (part 1) - 28/05/26
, Paul Boulard b, Oriana Ciacio a, Fabien Robin c, Kayvan Mohkam d, Agnès Rode e, François Faitot f, Joris Couillerot d, Sophie Chopinet g, Charlotte Maulat bHighlights |
• | Gallbladder stones results from biliary oversaturation and vesicular stasis, leading to the formation of cholesterol gallstones. |
• | Laparoscopic cholecystectomy is indicated in the event of symptomatic or complicated lithiasis; prophylactic indications remain exceptional. |
• | Acute cholecystitis is treated in accordance with the Tokyo guidelines, calling for early surgery when the patient's general condition is favorable. |
• | In the event of severe pedicular inflammation resulting in hazardous dissection, alternative techniques are to be considered: conversion to laparotomy, anterograde cholecystectomy, or subtotal cholecystectomy. |
Summary |
Cholelithiasis (gallstones) is a frequent disease, with an estimated annual risk of 1 to 4% of presenting clinical manifestations. It mainly results from imbalanced bile composition: cholesterol oversaturation, low levels of bile acids and gallbladder stasis resulting in the formation of gallstones. Two main types of gallstones exist: cholesterol gallstones (the most frequent), and pigment gallstones. The risk factors for lithiasis are multiple: age, female sex, rapid weight fluctuations, certain medical treatments, pregnancy, and a number of pathologies (diabetes, obesity, cirrhosis, Crohn's disease…). While lithiasis is often asymptomatic, approximately 20% of patients present with biliary colic or can develop severe complications: acute cholecystitis, stone migration, cholangitis or acute pancreatitis. In the event of symptomatic complications, laparoscopic cholecystectomy is the standard treatment. In the absence of clinical evidence, however, a conservative attitude is generally recommended, except in situations involving a risk of malignant transformation (large gallstones, adenomatous polyps, incomplete porcelain gallbladder…). Even though surgical technique is codified in terms of Critical View of Safety (CVS), the role of intraoperative cholangiography remains debated. Acute cholecystitis is managed according to the degree of severity and taking into account the Tokyo recommendations; available options range from early surgery to percutaneous drainage in the setting of major surgical risk. Management in pregnant women, elderly patients and cirrhotic patients, is individualized insofar as these populations present a risk of complications needing a personalized therapeutical approach.
Le texte complet de cet article est disponible en PDF.Keywords : Cholelithiasis, Acute lithiasic cholecystitis, Cholangiography, Cholecystectomy, Bile duct injury
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