What are the indications for cholecystectomy in patients with symptomatic gallstones?

Guideline-aligned answer with reasoning, red flags and references. Clinically reviewed by Dr Kola Tytler MBBS CertHE MBA MRCGP.

Posted: 14 August 2025Updated: 14 August 2025 Guideline-Aligned (High Confidence) Clinically Reviewed
Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX

Indications for cholecystectomy in patients presenting with symptomatic gallstones include:

  • Diagnosis of symptomatic gallbladder stones, where laparoscopic cholecystectomy is offered as the treatment of choice .
  • Acute cholecystitis, where early laparoscopic cholecystectomy should be performed within 1 week of diagnosis ,.
  • Symptomatic common bile duct stones, where bile duct clearance and laparoscopic cholecystectomy are recommended .
  • Gallbladder empyema when surgery is contraindicated initially and conservative management fails, percutaneous cholecystostomy is used, with reconsideration of cholecystectomy once the patient is stable .

Patients with asymptomatic gallstones generally do not require cholecystectomy unless there are specific risk factors such as a porcelain gallbladder, but this is an exception rather than the rule .

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