In 1882, Langenbuch performed the first cholecystectomy.<sup>7 Ammon H.V., Hofmann A.F. The Langenbuch paper: II. A translation Gastroenterology 1983 ;  85 : 1430

Cliccare qui per andare alla sezione Riferimenti, 58 Langenbuch C. Ein Fall von Exstirpation der Gallenblase wegen chronischer Cholelithiasis Berliner Klinische Wochenschrift 1882 ;  19 : 725

Cliccare qui per andare alla sezione Riferimenti</sup> At the time, he hypothesized that removing the gallbladder was necessary because it was a culprit in stone formation. Previously the gallbladder was believed to be a simple storage organ and an innocent bystander. Subsequent investigations have supported Langenbuch's hypothesis. Once the gallbladder is removed, formation of recurrent cholesterol gallstones is extremely rare. It is well documented that secretion of supersaturated bile by the liver is essential for cholesterol stone formation; however, this abnormality is not altered by cholecystectomy. In addition, gallbladder stasis is another well-recognized risk factor for stone formation. Together, these observations point to a role of local factors in gallstone pathogenesis. In the absence of a gallbladder, hepatic bile passes into the duodenum within minutes to hours. With an intact gallbladder, however, bile can be stored in the gallbladder for hours, days, or even weeks. This storage time is essential to allow cholesterol crystals to nucleate, calcium salts to precipitate, and stones to grow. In addition, the gallbladder may modify bile in a way that promotes stone formation, for example, by concentrating bile or by modifying the quantity and composition of biliary proteins. This article discusses factors promoting or inhibiting crystal nucleation and the role of the gallbladder in gallstone formation.