Avoid routine cholecystectomy for patients with asymptomatic cholelithiasis.
10-20% of people in Western countries have gallstones and 50-70% of these are asymptomatic. Incidental discovery of gallstones on imaging performed for unrelated reasons is common, often prompting surgical consultation. Treatment with observation alone is indicated for asymptomatic patients with incidental cholelithiasis, unless diagnosed with related hematologic disease. Cholecystectomy for patients with asymptomatic cholelithiasis is too aggressive. For asymptomatic cholelithiasis patients undergoing an unrelated abdominal operation, such as gastric bypass, concomitant cholecystectomy may be considered.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (comprised of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top five recommendations were then selected for inclusion in this list.
SAGES guideline for the application of laparoscopic biliary tract surgery. Available at https://www.sages.org/publications/guidelines/guidelines-for-the-clinical-application-of-laparoscopic-biliary-tract-surgery/.
Sakorafas GH, et al: Dig Dis Sci 2007 May;52(5)1313-25
Williams CI, et al: Current Treatment Options in Gastroenterology 11(2)71-77.