JAMA & ARCHIVES
Arch Fam Med
SEARCH
GO TO ADVANCED SEARCH
HOME  PAST ISSUES  TOPIC COLLECTIONS  CME  PHYSICIAN JOBS  CONTACT US  HELP
Institution: STANFORD Univ Med Center  | My Account | E-mail Alerts | Access Rights | Sign In
  Vol. 2 No. 9, September 1993 TABLE OF CONTENTS
  Archives
  •  Online Features
  Original Contributions
 This Article
 •References
 •Full text PDF
 •Send to a friend
 • Save in My Folder
 •Save to citation manager
 •Permissions
 Citing Articles
 •Citation map
 •Citing articles on HighWire
 •Contact me when this article is cited
 Related Content
 •Similar articles in this journal

Asymptomatic Gallstones Revisited

Is There a Role for Laparoscopic Cholecystectomy?

A. Mark Fendrick, MD; Sean P. Gleeson, MD, MBA; Michael D. Cabana; J. Sanford Schwartz, MD

Arch Fam Med. 1993;2(9):959-968.


Abstract

Objective
To compare the mortality effects of prophylactic laparoscopic cholecystectomy with that of expectant management in persons with asymptomatic gallstones.

Design
Decision analytic models of the two clinical strategies using input data from a review of the published medical literature pertaining to the epidemiology, natural history, and treatment outcomes related to gallstone disease.

Patients
Cohorts of men and women aged 30 and 50 years with asymptomatic gallstones.

Intervention
Prophylactic laparoscopic cholecystectomy performed at the time of diagnosis of asymptomatic gallstones or expectant management, defined as therapeutic intervention delayed until gallstone symptoms or complications spontaneously develop.

Main Outcome Measures
Gallstone-related deaths and gallstone-related life-years lost for each age and gender cohort, by strategy. Models were subjected to rigorous sensitivity analysis to test the robustness of the results to changes in individual input variables. Outcomes were calculated with and without discounting nonfinancial benefits.

Results
The prophylactic laparoscopic cholecystectomy strategy led to fewer gallstone-related deaths than the expectant management strategy, but all of the deaths in the prophylactic laparoscopic cholecystectomy group occurred earlier in life. In cohorts older than age 30 years, the expectant management strategy resulted in fewer undiscounted gallstone life-years lost than the prophylactic laparoscopic cholecystectomy strategy. Discounting favored expectant management further because life-years lost were delayed compared with prophylactic surgery. Sensitivity analysis demonstrated the superiority of expectant management over a wide range of input assumptions.

Conclusions
Prophylactic laparoscopic cholecystectomy should not be routinely recommended for individuals with asymptomatic gallstones.



Author Affiliations

From the Robert Wood Johnson Clinical Scholars Program (Dr Fendrick); the Leonard Davis Institute of Health Economics (Drs Fendrick and Schwartz); the Department of Health Care Systems, Wharton School of Business (Drs Fendrick, Schwartz, and Gleeson); the Division of General Internal Medicine, Department of Medicine, University of Pennsylvania School of Medicine (Drs Fendrick and Schwartz); and the University of Pennsylvania School of Medicine (Drs Fendrick, Schwartz, and Gleeson and Mr Cabana), Philadelphia.



THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Post-cholecystectomy diarrhoea: a running commentary
O'DONNELL
Gut 1999;45:796-797.
FULL TEXT  

Falling Cholecystectomy Thresholds Since the Introduction of Laparoscopic Cholecystectomy
Escarce et al.
JAMA 1995;273:1581-1585.
ABSTRACT  




HOME | CURRENT ISSUE | PAST ISSUES | TOPIC COLLECTIONS | CME | PHYSICIAN JOBS | HELP
CONDITIONS OF USE | PRIVACY POLICY | CONTACT US | SITE MAP
 
© 1993 American Medical Association. All Rights Reserved.