Management of Asymptomatic Cholelithiasis

Asymptomatic gallstones are found in approximately 10%–20% of the adult population, with only 1%–4% developing symptoms annually. Although complications such as biliary colic, acute cholecystitis or pancreatitis may occur, the overall risk remains low. Laparoscopic cholecystectomy, though effective with a >95% success rate, carries a morbidity of ~2%–6% and a mortality risk of <0.5%, making routine surgery unwarranted in most asymptomatic individuals. Observation is recommended in most cases. Prophylactic cholecystectomy is considered for high-risk groups, including patients with gallstones >2–3 cm, those with sickle cell disease or candidates for bariatric or organ transplant surgery. While the risk of gall bladder cancer in asymptomatic cholelithiasis is <0.3%, enhanced surveillance is advised in regions with high cancer prevalence. Routine cholecystectomy for cancer prevention is not supported by current evidence.