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Cholecystectomy for Asymptomatic Gallstones: Clinicopathological Study
Mohammad Ibrarullah1, Manas R Baisakh2, Ambika Prasad Dash3, Asutosh Mohapatra4,  Sangram Keshari Sahoo1, Apurva Agarwal6
Department of 1Surgical Gastroenterology, 2Pathology, 3General Surgery, 4Gastroenterology and 6Pathology, Apollo Hospitals, Bhubaneswar - 751012, Odisha, India 

Corresponding Author
Dr. Mohammad Ibrarullah


Background: Treatment of asymptomatic gallstones is a matter of debate.
Aim: The present study was undertaken to find justification for prophylactic cholecystectomy. 
Method: The clinical profile, safety of cholecystectomy and extent of histological changes, in patients with asymptomatic gallstones were evaluated. 
Result: 150 consecutive patients with incidentally detected gallstones were included in the present study. 122 patients underwent laparoscopic cholecystectomy alone. The procedure was converted to open cholecystectomy in one (0.8%).The duration of surgery was less than 1 hr in 96, between 1-2 hrs in 30 and more than two hrs in 24 patients.  There was no postoperative death and no major complications. Histology of gallbladder specimen showed features of chronic cholecystitis in all patients. In addition, gastric metaplasia, intestinal metaplasia and dysplasia, considered to be precursors of malignancy, were also noted in significant number of patients. Adenocarcinoma and carcinoma in situ were reported in one patient each (1.3%).  
Conclusion: Our study has shown that laparoscopic cholecystectomy is technically less demanding and can be safely performed in patients with asymptomatic gallstones. Despite clinically being silent, the stone/s induces inflammatory changes in the gallbladder wall that may predispose to malignancy. A slightly higher incidence of malignancy in the present series may be a reflection of endemicity of the disease. Hence, cholecystectomy should be offered to good risk patients even if the patient has asymptomatic gall stone disease.