GALLSTONE RECURRENCE AND ITS MANAGEMENT

Following non-surgical therapy, gallstones recur in 50% of patients within 5 years but not thereafter. Early reports overestimated the risk of recurrence because inadequate techniques were used to diagnose complete gallstone dissolution and inappropriate analysis of results. The main risk factors associated with gallstone recurrence are the presence of multiple primary stones, suggesting a possible nucleation defect, and the duration of primary dissolution therapy. Preventative trials have concentrated on reducing bile lithogenecity by the administration of low-dose maintenance bile acids at bed-time or by dietary means, but the results have been disappointing. Recurrent stones are associated with symptoms in a large proportion of patients and necessitate treatment. They have similar characteristics to primary stones with regard to radiolucency and gall bladder opacification, indicating that non-surgical therapy is suitable. In the majority of patients, recurrent stones are multiple and small, and bile acid is the best form of retreatment. Intermittent bile acid therapy prevents the recurrence of gallstones in the majority of patients and at present represents the most viable strategy for the long-term non-surgical management of gallstones.