When should laparoscopic cholecystectomy be considered for the treatment of asymptomatic (silent) gallstones?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Patients who are immunocompromised, are awaiting organ allotransplantation, or have sickle cell disease are at higher risk for the development of complications and should be treated irrespective of the presence or absence of symptoms.

Additional reasons to consider prophylactic laparoscopic cholecystectomy include the following:

  • Calculi greater than 3 cm in diameter, particularly in individuals in geographic regions with a high prevalence of gallbladder cancer
  • Chronically obliterated cystic duct
  • Nonfunctioning gallbladder
  • Calcified (porcelain) gallbladder [9]
  • Gallbladder polyp larger than 10 mm or showing a rapid increase in size [10]
  • Gallbladder trauma [8]
  • Anomalous junction of the pancreatic and biliary ducts

Morbid obesity is associated with a high prevalence of cholecystopathy, and the risk of developing cholelithiasis is increased during rapid weight loss. Routine prophylactic laparoscopic cholecystectomy before Roux-en-Y gastric bypass (RYGB) is controversial, but laparoscopic cholecystectomy should clearly precede or be performed concurrently with RYGB in patients with a history of gallbladder pathology. [11]


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