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ASYMPTOMATIC CHOLELITHIASIS: EXPECTANT OR CHOLECYSTECTOMY. A SYSTEMATIC REVIEW.

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¹Universidade Federal de Santa Catarina, Department of Surgery - Florianópolis (SC), Brazil.

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Summary

Conservative treatment is generally safe for asymptomatic gallstones. Prophylactic cholecystectomy may be considered for post-cardiac transplant patients and those with biliary microlithiasis, but more evidence is needed.

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Area of Science:

Gastroenterology
Surgical Oncology

Background:

Asymptomatic cholelithiasis (gallstones) is common, necessitating evaluation of prophylactic cholecystectomy risks and benefits.
Increased access to imaging has highlighted the prevalence of silent gallstones.
The decision between prophylactic surgery and conservative management requires careful consideration.

Approach:

A systematic review of PubMed/Medline (April 2001-January 2022) was conducted following PRISMA guidelines.
Search terms included "asymptomatic" or "silent" AND "gallstones" or "cholelithiasis" for individuals over 18.
Eighteen studies were selected, supplemented by the Tokyo Guideline (2018) for comprehensive analysis.

Key Points:

Conservative treatment (clinical follow-up) is largely safe and feasible for asymptomatic gallstones.
Prophylactic cholecystectomy is recommended for post-cardiac transplant recipients.
Patients with biliary microlithiasis and low surgical risk may also benefit from prophylactic surgery.

Conclusions:

Current evidence supports conservative management for most asymptomatic gallstone cases.
Specific patient groups, like post-cardiac transplant and those with biliary microlithiasis, warrant further investigation regarding prophylactic cholecystectomy.
Higher-level evidence studies are required to solidify recommendations for prophylactic cholecystectomy.