Clinical economics review: the management of gallstone disease.

Surgical techniques have an inherent advantage over oral bile therapy and extracorporeal shock-wave lithotripsy because they remove both gallstones and the gallbladder, thus preventing stone recurrence. Moreover, surgical techniques are more effective for patients with symptomatic gallstones compared with non-surgical techniques. Laparoscopic surgery is the best therapy from the clinical economic viewpoint being cost-minimal, effective and beneficial compared with other surgical and medical techniques. However, non-surgical techniques may be preferable in selected patients at high risk from general anaesthesia such as the elderly and those with significant cardiopulmonary disease.