Asymptomatic cholelithiasis: when make surgery?

Abstract

The cholelithiasis can present itself in three ways: asymptomatic, symptomatic and complicated. The conduct in asymptomatic patients is often controversial. With the aim of identifying the conduct of gastroenterologists and surgeons facing the diagnosis of asymptomatic cholelithiasis and establish a consensus, sent a questionnaire with 21 questions to 23 gastroenterologists, 108 surgeons and 101 surgeons general of the digestive tract. Participants in the study agreed on the indication of cholecystectomy in the following questions: diagnostic ultrasound of cholelithiasis; gallstones below 0.5 cm, and above 2cm; gallbladder in porcelain; patients below 20 years; carriers of sickle cell anemia and diabetes and the concomitant laparotomy because no biliary, using the same incision. Only surgeons general and the digestive tract indicate cholecystectomy: in asymptomatic patients over 60 years, in morbidly obese, in the presence of two or more risk factors for cholelithiasis; abdominal surgery with the need to enlarge the incision; in patients with dyspeptics symptoms and normal endoscopy, refractory to clinical treatment or with atypical symptoms, in women with prospect of future pregnancies and as the wish of the patient. In asymptomatic patients over 70 years, only the surgeons of the digestive tract indicate cholecystectomy. Professionals agree to the non-cholecystectomy indication of the candidates for liver transplantation. We note, therefore, that there is agreement on the conduct of the 21 questions in 11 surveyed (52.3%), with divergence in the remaining items (47.7%). Thus, in agreement with the literature, it is not yet possible to establish a consensus for treatment of cholelithiasis asymptomatic.