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Should cholecystectomy be done en passant for asymptomatic cholelithiasis?
Insights
Management of incidental gallstones during abdominal surgery is debated. Performing cholecystectomy (gallbladder removal) en passant is recommended due to low morbidity and fewer subsequent surgeries needed.
Area of Science:
- Surgical Management
- Gastroenterology
- Abdominal Surgery
Background:
- Asymptomatic gallstones found during unrelated abdominal surgery present a management dilemma.
- The decision to perform cholecystectomy (gallbladder removal) en passant is controversial.
Purpose of the Study:
- To evaluate the outcomes of incidental asymptomatic gallstones discovered during abdominal surgery.
- To assess the safety and necessity of performing cholecystectomy en passant.
Main Methods:
- A 4-year survey of 109 patients with asymptomatic cholelithiasis undergoing surgery for other abdominal conditions.
- Comparison of outcomes between patients who underwent cholecystectomy en passant and those who did not.
Main Results:
- 52% of gallstones were detected preoperatively via ultrasonography; 48% were discovered intraoperatively.
- In patients who had cholecystectomy en passant (n=78), 14% experienced complications.
- In the non-cholecystectomized group (n=31), 24% developed symptoms requiring later surgery, including acute cholecystitis.
Conclusions:
- Cholecystectomy en passant is recommended for asymptomatic gallstones unless contraindicated, due to low morbidity and reduced need for future procedures.
- Preoperative ultrasonography is advised before major gastrointestinal or vascular surgery to facilitate planning for incidental gallstone management.
Abstract:
The management of asymptomatic gallstones discovered during abdominal surgery is controversial. Should cholecystectomy be performed en passant? The authors report a 4-year survey of 109 patients with asymptomatic cholelithiasis who underwent surgery for other abdominal conditions: colorectal (31), gastric (24), vascular (20), gynecologic (21) and miscellaneous (13). Cholelithiasis was established preoperatively by ultrasonography in 52 of 55 examinations (95%). In the other 54, the gallstones were discovered at operation. Cholecystectomy was performed in 78 patients and in 31 the gallbladder was left in place. In the former group, 11 (14%) had complications, 2 being attributable to the cholecystectomy. Intraoperative cholangiograms were obtained in 43 and led to common-bile-duct explorations in 8. Common-bile-duct stones were found in seven. In the non-cholecystectomized group, three died postoperatively and three were lost to follow-up. Twelve of the remaining 25 are still asymptomatic and 13 have had symptoms: 7 underwent cholecystectomy (4 for acute cholecystitis) between 2 weeks and 11 months after the initial laparotomy. Because of the low morbidity and the relatively high number of cholecystectomies that were subsequently necessary, the authors recommend cholecystectomy en passant unless there is a specific contraindication. They also recommend ultrasonography before major gastrointestinal or vascular surgery in order to plan for cholecystectomy.