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News

Cholecystectomy is not needed for asymptomatic cholelithiasis

Cholecystectomy for silent gallstones is a too aggressive management option, and not indicated for asymptomatic cholelithiasis, finds this month's Digestive Diseases and Sciences.

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Asymptomatic cholelithiasis is increasingly diagnosed today.

This is mainly as a result of the widespread use of abdominal ultrasonography for the evaluation of patients for unrelated or vague abdominal complaints.

Dr George Sakorafas and team from Greece reviewed the literature to assess whether cholecystectomy is really needed for asymptomatic cholelithiasis.

The team report that about 10% to 20% of people in most western countries have gallstones.

Among these, 50% to 70% are asymptomatic at the time of diagnosis.

The progression of asymptomatic disease ranges from 10% to 25%
Digestive Diseases and Sciences

Asymptomatic gallstone disease has a benign natural course.

The progression of asymptomatic to symptomatic disease is relatively low, ranging from 10% to 25%.

The team noted that the majority of patients rarely develop gallstone-related complications without first having at least one episode of biliary pain.

In the prelaparoscopy era, the team observed that open cholecystectomy was generally performed for symptomatic disease.

The minimally invasive laparoscopic cholecystectomy refueled the discussion about the optimal management of asymptomatic cholelithiasis.

The researchers found that, despite some controversy, most authors agree that the vast majority of subjects should be managed by observation alone.

Selective cholecystectomy is indicated in defined subgroups of subjects.

The team noted that these subjects have an increased risk for the development of gallstone-related symptoms and complications.

Concomitant cholecystectomy is a reasonable option for good-risk patients with asymptomatic cholelithiasis undergoing abdominal surgery for unrelated conditions.

Dr Sakorafas' team concluded,” Routine cholecystectomy for all subjects with silent gallstones is a too aggressive management option, not indicated for most subjects with asymptomatic cholelithiasis.”

“An in-depth knowledge of the natural history of gallstone disease is required to select the optimal management option for the individual subject with silent gallstones.”

“Management options should be extensively discussed with the patient.”

“The patients should be actively involved in the process of therapeutic decision making.”

Digestive Diseases and Sciences 2007: 52(5): 1313-25
25 April 2007

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