When should I consider referring a patient with biliary colic for surgical intervention?

Consider referring a patient with biliary colic for surgical intervention (laparoscopic cholecystectomy) when they have symptomatic gallstone disease. This includes patients who experience biliary colic pain attributable to gallstones, even if the pain is self-limiting but recurrent.

Urgent referral is indicated if the patient is systemically unwell or there is suspicion of complications such as acute cholecystitis, cholangitis, or pancreatitis. In these cases, emergency admission and surgical assessment are required.

For acute cholecystitis, early laparoscopic cholecystectomy should be offered within 1 week of diagnosis. For other symptomatic gallstone disease without acute complications, elective day-case laparoscopic cholecystectomy is appropriate unless inpatient stay is clinically necessary.

Referral urgency depends on clinical judgement, but all patients with symptomatic gallstones should be referred to a surgeon to consider cholecystectomy.

Additionally, if there is jaundice or clinical suspicion of biliary obstruction (e.g., abnormal liver function tests), urgent referral to gastroenterology or surgical services with biliary expertise is recommended.