[Therapy of asymptomatic gallstones: indications and limits]

Abstract

Gallstone disease is one of the most common health problems world-wide. It is also one of the main causes of medical expenditure in Western countries. Asymptomatic gallstones are defined as stones that have not given rise to biliary cholic or other biliary symptoms. A number of epidemiological cross-sectional screening studies have shown that as many as 66 to 77% of patients with gallstones are asymptomatic. Opinion regarding the development of the disease in the asymptomatic patients has changed in the course of time. In 1992 Friedman, in his review of literature, established that only 1-2% of asymptomatic patients developed severe symptoms or complications early, with fewer complications developing in later years than in the years soon after discovery of the gallstones. Recent prospective epidemiological studies have established that no particular factor has any effect on the natural course of the disease. Laparoscopic cholecystectomy is the gold standard for symptomatic gallstones, but the management of patients with asymptomatic stones remains controversial. This problem is related to the incidence of biliary lesions which has remained substantially unchanged over the past few years. It has recently been demonstrated that the risk of iatrogenic lesions is not entirely dependent upon the surgeon's experience. There is a substantial consensus of agreement that surgical treatment has an unfavourable cost:benefit ratio in asymptomatic patients. The Authors conclude that, because of the condition's benign natural history, a wait-and-see policy is to be recommended in all asymptomatic patients, except for only a few selected cases.