PROPHYLACTIC CHOLECYSTECTOMY FOR SILENT GALLSTONE DISEASE

Abstract

Asymptomatic gallstones are defined as stones that have not caused biliary colics or other biliary symptons. Some crosssectional epidemiological screening studies have shown that as many as 66% to 77% of patiens with gallstones are asymptomatic. Studies of natural history suggest that the cumulative probability of devoloping biliary colics after ten years ranges from 15% to 25%. None of the variables considered as possible modifiers of natural history, were found to be associated with an increased risk of incidence of biliary colics. Cholecystectomy is a vary safe treatment and is being performed with near zero mortality. T wo are the possible strategies compared: prophylactic cholecystectomy with expectant management for silent gallstone disease. Consideration of survival and monetary costs disfavors prophylactic cholecystectomy. The results of laparoscopic cholecystectomy compare favorably with those of open cholecystectomy with respect to mortality, complications, length of hospital stay, cosmetically satisfactory and financial benefits. Patients with asymptomatic stones in the gallbladder require neither surgical nor medical treatment. Consideration of monetary costs disfavors prophylactic cholecystectomy: a waiting attitude has the advantage of lowering the sanitary costs also for the high incidence of silent gallstones in our population.