Indications to laparoscopic cholecystectomy

The diffuse ultrasound examination for various abdominal diseases increased in the last decades the diagnosis of asymptomatic gallbladder diseases. High-quality data demonstrate that the majority of patients with asymptomatic gallstones will remain asymptomatic (only 2–4 % will develop symptoms annually) and that the complication rate in asymptomatic patients ranges from 0.3 to 3 % per year. Given the low incidence of symptoms development and complication rate per year in nontreated patients, prophylactic laparoscopic cholecystectomy is currently not recommended as standard treatment. N evertheless, according to the conclusion of 2009 Cochrane Review on LC in silent stones, there is no RCT or high-level studies which offer scientifi c evidence to refuse LC to asymptomatic gallbladder stone patients. There is no evidence to recommend prophylactic LC in asymptomatic gallbladder stone patients neither for diabetics, patients on long-term somatostatin, nor patients with porcelain gallbladder in Western countries. Also in patients with gallbladder stones >3 cm, there is not enough data available to recommend prophylactic LC to prevent gallbladder cancer. Nevertheless, recent data suggest that selective prophylactic LC is advisable in some subgroup of patients. Microcalculi and bile sludge in conjunction with a functioning gallbladder are more likely to predispose patients to calculi migration and subsequent onset of choledocholithiasis and acute pancreatitis. Incidental diagnosis of cholelithiasis in preoperative or intraoperative setting for other medical conditions can be treated laparoscopically in the same session if it does not add any risk of conversion and no prosthetic material is being used. A s the risk of sickling, in patients suffering from sickle cell anemia, is reduced by a laparoscopic approach, it should be the fi rst choice. Some ethnic groups and inhabitants of certain geographical areas are more likely to develop gallbladder cancer. Also specifi c ultrasound fi ndings, like selective mucosal calcifi cations, increase the risk of gallbladder cancer. These patients could benefi t from prophylactic LC. C ardiac-transplanted patients with asymptomatic cholelithiasis should undergo LC.