Biliary stones

Although supersaturation of bile with cholesterol is necessary for cholesterol precipitation and gallstone formation, it is not sufficient. The realization that phospholipid-cholesterol vesicles, as well as mixed micelles, are important cholesterol carriers in bile and that nucleating and antinucleating substances in bile determine when and if precipitation will occur once supersaturation is reached has greatly enhanced our understanding of cholesterol-gallstone pathogenesis. Our current understanding of these concepts and the techniques used to examine their role in gallstone pathogenesis were well summarized during the past year, largely due to publication of the proceedings of the National Institutes of Health-sponsored symposium ″Biliary Cholesterol Transport and Precipitation″. In addition, interest in alternatives to cholecystectomy, such as extracorporeal shock-wave lithotripsy, percutaneous extraction of gallstones, and laparoscopic cholecystectomy, has been high. Laparoscopic cholecystectomy seems to be safe and applicable in most patients. It is rapidly gaining recognition as the procedure of choice in most patients.