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

For patients presenting with symptomatic gallstones, the primary indication for cholecystectomy is the presence of the symptoms themselves ¹,². Laparoscopic cholecystectomy is the recommended surgical treatment for individuals diagnosed with symptomatic gallbladder stones ¹. This procedure is considered the surgical treatment of choice for gallstone disease (Lamberts, 2018; Potts JR 3rd, 1990).

Specific symptomatic conditions and complications that indicate cholecystectomy include:

• Acute Cholecystitis: For people with acute cholecystitis, early laparoscopic cholecystectomy should be offered, ideally carried out within 1 week of diagnosis ¹,³. This is because gallbladder inflammation often persists despite medical therapy ³. Patients with suspected acute cholecystitis should be admitted to hospital for surgical assessment ³.
• Common Bile Duct Stones: Whether symptomatic or asymptomatic, common bile duct stones warrant bile duct clearance followed by laparoscopic cholecystectomy due to the significant risk of developing serious complications such as cholangitis or pancreatitis ¹,².
• Gallbladder Empyema: In cases of gallbladder empyema where surgery is initially contraindicated and conservative management is unsuccessful, percutaneous cholecystostomy may be offered as a temporary measure. Laparoscopic cholecystectomy should then be reconsidered once the patient is well enough for surgery ¹.

In contrast, asymptomatic gallbladder stones in a normal gallbladder and biliary tree generally do not require treatment unless symptoms develop, as the risks of prophylactic surgical treatment typically outweigh the potential risks from the stones themselves ¹,².