When should cholecystectomy be considered for asymptomatic 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

However, cholecystectomy for asymptomatic gallstones may be indicated in the following patients:

  • Patients with large gallstones, greater than 2 cm in diameter (In a case-control study of 81 gallbladder cancer cases, the risk of malignancy was more than doubled [odd ratio: 2.4] for patients with gallstone diameters of 2.0-2.9 cm; the neoplastic risk was more than 10-fold [10.1] in those with gallstone diameters of ≥3 cm. [22] These findings suggested implications for the management of asymptomatic gallstones, including annual follow-up with physical examination, abdominal ultrasonography, and other studies as appropriate. [21] )

  • Patients with nonfunctional or calcified (porcelain) gallbladder observed on imaging studies and who are at high risk of gallbladder carcinoma

  • Patients with spinal cord injuries or sensory neuropathies affecting the abdomen

  • Patients with sickle cell anemia in whom the distinction between painful crisis and cholecystitis may be difficult


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