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Surgery to treat gallstones and acute inflammation of the gallbladder

A systematic review and assessment of the social, medical, economic and ethical aspects

SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

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Conclusions

  • It is unclear whether patients experiencing a gallstone attack should receive surgical treatment or not. The scientific basis to assess this is insufficient and better studies are needed.
  • The body of evidence is currently insufficient to determine whether it is better to always surgically treat acute inflammation of the gallbladder. More well conducted studies are needed.
  • Patients with acute inflammation of the gallbladder can be surgically treated in the acute phase, within a few days of symptom debut, without increasing the risk for complications (compared to when the surgery is done later in an asymptomatic stage). Increasing the number of surgeries performed during the acute phase could free resources for the health care system. Just over 60% of surgeries for acute inflammation of the gallbladder are currently performed during the acute phase. SBU estimates that increasing acute phase surgeries to 90% could free three in-hospital days per patient, or about 3300 days per year (corresponding to nearly 26 million Swedish crowns yearly). What is more, patients who receive acute phase surgery are spared experiencing additional pain and suffering while they wait for their operation.
  • The risk for complications is reduced when patients with acute inflammation of the gallbladder are treated using laparoscopic surgical techniques compared to open surgery techniques. 

Table of included studies

Search strategies

Table of excluded studies

Project group

Experts

Claes Jönsson (Chair, Associate Professor, Göteborg)
Agneta Montgomery (Associate Professor, Malmö)
Lars Enochsson (Associate Professor, Umeå)
Bengt Hallerbäck (Associate Professor, Trollhättan)
Peter Leander (Associate Professor, Malmö)
Johanna Österberg (PhD, Consultant, Mora)
Mikael Lilja (PhD, General Practitioner, Östersund)

SBU

Jan Adolfsson (Project Manager)
Anna Westlind Johnsson (Assistant Project Manager until August 2015)
Pia Johansson (Health Economists)
Anders Norlund (Health Economists)
Hanna Olofsson (Information Specialists)
Maja Kärrman Fredriksson (Information Specialists)
Anneth Syversson (Project Administrator)
Sigurd Vitols (Medical Advisor)

Scientific reviewers

Linda Bardram (Associate Professor, Copenhagen, Denmark)
Björn Edwin (Professor, Oslo, Norway)

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Cholecystitis: Surgery works best at an early stage and with laparoscopic technique

Surgery for cholecystitis (inflammation of the gallbladder) works best within a few days of diagnosis. The period of convalescence could be reduced by three days per patient and save SEK 26 million a year. Acute cholecystitis could be operated on even more often with laparoscopic (keyhole) technique.

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