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Updated: Jul 23, 2025
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Laparoscopic Common Bile Duct Exploration in Patients with a Previous History of Biliary Tract Surgery
Published on: February 10, 2023
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ASYMPTOMATIC CHOLELITHIASIS: EXPECTANT OR CHOLECYSTECTOMY. A SYSTEMATIC REVIEW
Jose Roberto Alves1, Diurlhane Mainara Klock2, Filipe Gonçalves Ronzani2
1Universidade Federal de Santa Catarina, Department of Surgery - Florianópolis (SC), Brazil.
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.
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.
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