Introduction
Approximately 10-15 percent of the adult population or more than 20 million people in the United States have gallstones. About 1 million new patients are diagnosed annually. Gallstones are more common in women, older patients, and certain ethnic groups, and are associated with multiple pregnancies, obesity, and rapid weight loss. In 1991 approximately 600,000 patients underwent cholecystectomy (removal of the gallbladder).
Gallstones are composed principally of cholesterol. Stones tend to grow for the first 2-3 years, at such point growth tends to stabilize; 85 percent of all gallstones are less than 2 cm in diameter. Most patients with gallstones does not feel any discomfort and remain symptom-free for many years and many, in fact, never develop symptoms. However, the consequences of gallstones may be severe, ranging from brief episodes of biliary pain (misnamed "colic") to potentially life-threatening complications, such as acute infections of the gallbladder or pancreas, or rarely gallbladder cancer.
Until a decade ago, the prevailing surgical treatment of symptomatic gallstones was an open operation through an abdominal incision to remove the gallbladder.
Laparoscopic cholecystectomy is a minimally-invasive surgical procedure that is performed using laparoscopic visualization of the gallbladder and surrounding vital structures. This technique requires that only a few small (about half-inch) incisions be made in the abdominal wall. The gallbladder is removed through one of the small incisions, the laparoscope and instruments are removed, and the incisions are closed with sutures and covered with small bandages. The operation usually requires general anesthesia and is subject to the same risks and complications as open cholecystectomy. However, patients have little pain after the operation, and hospital stays (1-2 days) and recovery (1-2 weeks) are usually shorter than after open cholecystectomy. It is estimated that more than 15,000 surgeons have received some training in the technique of laparoscopic cholecystectomy, and demand for this form of surgery has escalated to the point where probably about 80 percent of cholecystectomies are being performed through this technique

Which Patients With Gallstones Should Be Treated? Symptomatic Gallstones
Once gallstone symptoms appear, they recur in the majority of patients. Furthermore, patients with symptoms secondary to gallstones are more likely (25 percent within 10-20 years) than asymptomatic patients to develop complications. Thus, most symptomatic patients should be treated. Pain from gallstones ('biliary pain') is often severe, episodic, lasting 1 to 5 hours, often waking the patient at night, and located above the bellybutton ('epigastria') or in the right upper quadrant of the abdomen. Biliary pain often flares soon after eating. Nearly 90 percent of patients with typical biliary pain are rendered symptom free after successful treatment of their gallstones. Those who are too ill to undergo general anesthesia should be managed with nonsurgical therapies.

Which Patients With Gallstones Should Be Treated With Laparoscopic Cholecystectomy?
Since the advent of laparoscopic cholecystectomy in 1988, this procedure has become the gold-standard for gallbladder removal. Most patients with symptomatic gallstones are candidates for laparoscopic cholecystectomy, if they are able to tolerate general anesthesia and have no serious cardiopulmonary diseases or other coexisting conditions that preclude operation.

Some patients with very serious complications from gallbladder disease may not be eligible for laparoscopic gallbladder removal. In addition, patients in the third trimester of pregnancy should not usually undergo laparoscopic cholecystectomy, because of risk of damage to the uterus during the procedure.

Laparoscopic cholecystectomy in the first trimester of pregnancy remains controversial because of the unknown effects of carbon dioxide on the developing fetus.