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 NICE CG188,NICE CKS. Laparoscopic cholecystectomy is the recommended surgical treatment for individuals diagnosed with symptomatic gallbladder stones NICE CG188. This procedure is considered the surgical treatment of choice for gallstone disease Lamberts 2018Potts 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 NICE CG188,NICE CKS. This is because gallbladder inflammation often persists despite medical therapy NICE CKS. Patients with suspected acute cholecystitis should be admitted to hospital for surgical assessment NICE CKS.
• 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 NICE CG188,NICE CKS.
• 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 NICE CG188.

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 NICE CG188,NICE CKS.