Further information on these tests can be found in Ch. Because asymptomatic gallstones are often discovered during evaluation of other problems, the question arises whether to recommend observation or elective cholecystectomy. Neither choice applies to all circumstances. Most patients with clinically silent stones decide that the discomfort, expense, and risk of elective surgery are not worth removing an organ that may never cause clinical illness, although the potential complications represent serious disease. If symptoms appear, prompt therapy is advisable.
Biliary colic recurs with irregular, pain-free intervals of days or months.
Symptoms often do not progress in severity or frequency, but neither do they cease. Symptomatic patients are at increased risk of developing complications, and cholecystectomy is indicated. Cholecystectomy does not result in nutritional problems, and no dietary limitations are required postoperatively. The standard operation for gallbladder removal through a right subcostal or midline incision is open cholecystectomy. However, since its introduction in 1988, laparoscopic cholecystectomy has been the treatment of choice for symptomatic gallstones.