Cholelithotomy

Cholelithotomy (sometimes simply referred to as lithotomy) is the surgical removal of a gall stone. The gall stone can be removed from within the gall bladder itself or it can be removed from a place elsewhere in the system, where it has become blocked. Surgeons commonly refer to this as simply removal of gall stone and rarely by the procedural name because it may become confused with cholecystectomy or with the lithotomy position.

There is a debate amongst surgeons as to whether the gall bladder should be removed "just in case" or if it should be kept "just in case". Amongst surgeons who believe that the gall bladder should be removed just in case, cholelithotomy is rarely performed, as they would prefer to remove the gall bladder entirely. Amongst surgeons who believe that the gall bladder should be retained just in case, cholelithotomy is a common procedure.

The debate is focussed on whether the gall bladder is a useful organ. Whilst it does assist with digestion, it malfunctions to an alarming degree and as such many surgeons believe that it should be removed anyway. On the other side of the argument is the fact that in patients with anaemia, reflux symptoms or severe allergies, removal of the gall bladder can be life-threatening in a long-term basis, and, even if the patient does not currently have those symptoms, if they developed them in the future, then their quality of life and life expectancy could be reduced by premature removal of the gall bladder.

There is no serious debate as to whether the gall bladder should be removed in cases where non-removal would be fatal. There is similarly no serious debate as to whether the gall bladder should be removed in cases where there is just a single gall stone and the patient suffers from serious life-threatening digestive problems (or potentially life-threatening were the gall bladder to be removed).

Amongst surgeons who advocate maintaining the gall bladder at all costs, they will typically cease performing a cholelithotomy at the 4th or 5th recurrence of a gall stone, as this indicates a grossly malfunctioning gall bladder, although they may continue to remove gall stones if the patient has major digestive problems.