Management of Asymptomatic (Silent) Gallstones
Gallstone formation is common among adults in the United States, with asymptomatic cholelithiasis identified in as many as 20% in some studies. The lifetime risk of complicated disease from initially silent gallstones (i.e., cholecystitis, pancreatitis, or carcinoma) is low but not negligible. Although the relative morbidity of laparoscopic cholecystectomy continues to decline since its advent in the 1980s, there is still occasional major morbidity associated with the procedure. The availability of endoscopic and percutaneous procedures for the management of complications of gallstone disease have further complicated decision making. Therefore, a thorough understanding of the relative risks of the procedure versus conservative management is foundational to individualizing surgical treatment recommendations for each patient. Specific populations in which cholecystectomy might be considered for asymptomatic gallstones include those undergoing surgery for weight loss, those with intestinal insufficiency (i.e., short gut syndrome), and those with congenital hemolytic anemias.
