An Indian surgeon's perspective on management of asymptomatic gallstones

Abstract

IntroductionCholelithiasis is widely prevalent in India, with a majority of patients being asymptomatic while a small proportion experiencing mild complications. In the laparoscopic era, the rate of cholecystectomies has increased owing to early recovery and fewer complications. In asymptomatic patients, the risk of complications must be balanced against the treatment benefit. Recent guidelines suggest no prophylactic cholecystectomy in asymptomatic patients. We aimed to find out the Indian surgeons' perspective on asymptomatic gallstone management.MethodsA cross‐sectional e‐survey was conducted of practicing surgeons, onco‐surgeons and gastrointestinal‐surgeons in India. The survey had questions regarding their perspective on laparoscopic cholecystectomy and treatment modalities in asymptomatic gallstones.ResultsA total of 196 surgeons responded to the survey. Their mean age was 42.3 years. Overall, 111 (57%) respondents worked in the private sector. Most surgeons (164) agreed that the rate of cholecystectomy has increased since the advent of laparoscopy; 137 (70%) respondents agreed that they would not operate on patients without risk factors. Common bile duct stones, chronic hemolytic diseases, transplant recipients, and diabetes mellitus were the risk factors. Majority of the participants agreed on not performing a cholecystectomy in patients with asymptomatic gallstones.ConclusionThere exists a lack of consensus among Indian surgeons on asymptomatic gallstone management in India. Where the majority of cases are asymptomatic and do not require surgery, certain comorbidities can influence the line of treatment in individual patients. Currently, the treatment guidelines for asymptomatic patients need to be established as cholecystectomies may be overperformed due to the fear of development of complications.

Cracking the silent gallstone code: Wait or operate?

“…Additionally, although a direct causal link between gallstones and GBC has not been definitively established, the potential risk cannot be entirely dismissed in populations with a high incidence of GBC, given the disease's poor prognosis and the challenges in early detection. The mere possibility of such a link, even without proven causation, can significantly influence the decision-making process for both patients and surgeons[ 35 ]. Therefore, it's crucial to acknowledge that future research is needed to provide updated and robust evidence to support informed treatment decisions.…”