When is surgical intervention indicated in the treatment of gallstones (cholelithiasis)?

Updated: Apr 01, 2019
  • Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
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Answer

The treatment of gallstones depends upon the stage of disease. [20] Ideally, interventions in the lithogenic state could prevent gallstone formation, although, currently, this option is limited to a few special circumstances. Asymptomatic gallstones may be managed expectantly.

Once gallstones become symptomatic, definitive surgical intervention with cholecystectomy is usually indicated (typically, laparoscopic cholecystectomy is the first-line therapy at centers with experience in this procedure). [21] Careful selection of patients is warranted and should fulfill the following criteria:

  • Small stone size (<0.5 to 1 cm)
  • Good gallbladder function (eg, normal filling and emptying)
  • Minimal or no calcification

Open surgery may be indicated when concomitant gallbladder cancer is present. [21]

In patients with complicated cholecystitis, stabilization of the patient and gallbladder drainage, followed by cholecystectomy, may be considered. [21]


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