Table of contents
Gallstone disease
What's new
Updated 2024 SAGES guidelines for the management of biliary colic during pregnancy.
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of gallstone disease are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024,2014), the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES 2024,2010), the Danish Surgical Society (DSS 2022), the American Society of Anesthesiologists (ASA/ACE/OS/AACE/ASMBS/OMA 2020), the World Society of Emergency Surgery (WSES ...
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Diagnostic investigations
History and physical examination: as per EASL 2016 guidelines, elicit medical history and perform a physical examination to identify characteristic findings of gallbladder stones (episodic attacks of severe pain in the right upper abdominal quadrant or epigastrium for at least 15-30 minutes with radiation to the right back or shoulder and a positive reaction to analgesics).
B
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Diagnostic imaging
Laboratory tests
Medical management
Expectant management: as per AAFP 2024 guidelines, offer expectant management in most patients with asymptomatic gallstones.
B
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Bile acid litholysis
Management of pain
Therapeutic procedures
Extracorporeal shock wave lithotripsy
As per JBA/JGES/JSG 2017 guidelines:
Offer extracorporeal shock wave lithotripsy in patients with gallstone disease refusing surgery.
B
Offer extracorporeal shock wave lithotripsy in patients with non-calcified cholesterol gallstones with normal gallbladder function.
B
Perioperative care
Surgical interventions
Cholecystectomy, indications: as per AAFP 2024 guidelines, consider performing prophylactic cholecystectomy in patients with asymptomatic gallstones having hemolytic anemia, anticipated organ transplantation, or NETs.
C
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Cholecystectomy (timing)
Cholecystectomy (choice of approach)
Cholecystectomy (technical considerations)
Cholecystectomy (management of postoperative leaks)
Specific circumstances
Elderly patients
As per EASL 2016 guidelines:
Perform cholecystectomy in the elderly and in patients with high anesthetic risk with gallstone complications (such as acute cholecystitis, gallstone pancreatitis, or obstructive jaundice) as soon as the general status allows surgery.
B
Do not withhold laparoscopic cholecystectomy solely based on the chronological age.
D
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Pregnant patients
Patients undergoing bariatric surgery
Preventative measures
Primary prevention, lifestyle interventions: as per EASL 2016 guidelines, consider advising healthy lifestyle and food, regular physical activity, and maintenance of ideal body weight to prevent the formation of cholesterol gallbladder stones and symptomatic gallstones.
C
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Primary prevention (pharmacological interventions)
Prophylactic cholecystectomy
Follow-up and surveillance
Discharge from hospital: as per SAGES 2010 guidelines, consider discharging patients undergoing uncomplicated laparoscopic cholecystectomy on the day of surgery. Ensure adequate control of postoperative pain, nausea, and vomiting for successful same-day discharge.
C
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Management of postoperative bile duct injury
Management of persistent symptoms