[Suitability of laparoscopic cholecystectomy in the asymptomatic cholelithiasis patient]

Cholelithiasis is a disease of high prevalence in the adult population. Prevalence increases with age; the incidence of complications, such as choledocholithiasis, acute pancreatitis, and cancer of gallbladder, also increase with age. Cholecystectomy has been considered as the gold standard in the treatment of symptomatic or complicated cholelithiasis. Laparoscopic cholecystectomy has become the new gold standard. Our Department of Surgery has adopted a policy of advising laparoscopic cholecystectomy in all patients with symptomatic cholelithiasis, but also subpopulation of high risk asymptomatic patients. This subgroup is made up by patients with long life expectancy, radioopaque stones, small calculus with patent cystic duct, nonfunctioning or calcified gall bladder, and patients with concomitant diabetes, cirrhosis, chronic hemolytic anemia, those that are candidates for kidney or heart transplantation, and those with underling degenerative diseases that are more likely to develop severe complication of cholelithiasis. Csendes of Chile has reported very high incidence of gallbladder cancer in Chile and Bolivia. He considers that cholecystectomy is indicated in asymptomatic patients as a "prophylactic" measure. Our group agrees that this is a valid indication in areas or populations groups where gallbladder cancer is of high prevalence.