Indications for Gallbladder Surgery in Gallstone Disease

• Randomized clinical trial (RCT) of observation versus surgery for uncomplicated gallstone disease
• RCT of observation versus operation for acute cholecystitis
• Study of outcome after cholecystectomy in patients from 1. and 2.
• Study of symptoms in gallstone disease and symptom relief after cholecystectomy
• Long-term morbidity and mortality, including cancer, after cholecystectomy
• Long-term follow-up of patients with silent gallstones

Inclusion criteria

• Symptomatic gallstone disease (SGBS):

Episodes of pain in the right subcostal or midline epigastric area lasting more than 30 min, with ultrasonography signs of gallstones.

• Ultrasonographic: echo with an acoustic shadow in a visible gallbladder, or an echo with positional change and size <3 mm or, alternatively no demonstrable gallbladder but a strong echo with an acoustic shadow in the position of the gallbladder

Exclusion criteria

SGBS:

• Infrequent and/or minimal pain that need only very occasional medication
• Age below 18 or above 80
• Not willing to participate

Inclusion criteria

, acute cholecystitis (AC):

• Acute abdominal pain
• Duration of more than 8-12 h
• Tenderness on clinical examination in the upper right quadrant
• Presence of gallbladder stones and signs of inflammation on ultrasonography and in clinical biochemistry data, including an elevated temperature

Exclusion criteria

, AC:

• Severe concomitant disease
• Suspected Common Bile Duct stone
• Acalculous cholecystitis
• Localized peritonitis suggesting gallbladder perforation or gangrenous cholecystitis

Inclusion criteria

1983 cohort of patients:

• Participation in a screening study for gallstones in 1983
• Operated for symptomatic gallstone disease in Bergen, Norway in 1983