I B |
Prophylactic cholecystectomy during gastrectomies did not represent significant extra operative time and was associated with minimal additional risks22 Bencini L, Marchet A, Alfieri S, Rosa F, Verlato G, Marrelli D, et al. The Cholegas trial: long-term results of prophylactic cholecystectomy during gastrectomy for cancer-a randomized-controlled trial. Gastric Cancer. 2019;22(3):632-9. https://doi.org/10.1007/s10120-018-0879-x https://doi.org/10.1007/s10120-018-0879-...
. Prophylactic cholecystectomy concomitant with oncologic gastrectomies had no significant impact on the natural history of cancer22 Bencini L, Marchet A, Alfieri S, Rosa F, Verlato G, Marrelli D, et al. The Cholegas trial: long-term results of prophylactic cholecystectomy during gastrectomy for cancer-a randomized-controlled trial. Gastric Cancer. 2019;22(3):632-9. https://doi.org/10.1007/s10120-018-0879-x https://doi.org/10.1007/s10120-018-0879-...
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The complication rate up to 30 days after cholecystectomy is 10.8%, the two main ones being reported as collection formation and infection of the operative wound11 Ahmed I, Innes K, Brazzelli M, Gillies K, Newlands R, Avenell A, et al. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ Open. 2021;11(3):e039781. https://doi.org/10.1136/bmjopen-2020-039781 https://doi.org/10.1136/bmjopen-2020-039...
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The natural course of the disease is benign and presents low lifetime mortality (less than 1% of people will die from gallstone-related causes)11 Ahmed I, Innes K, Brazzelli M, Gillies K, Newlands R, Avenell A, et al. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ Open. 2021;11(3):e039781. https://doi.org/10.1136/bmjopen-2020-039781 https://doi.org/10.1136/bmjopen-2020-039...
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About 20% of AC will become symptomatic in a mean follow-up time of 8.7 years, causing pain or complications (acute cholecystitis, empyema, choledocholithiasis, cholangitis, and pancreatitis)11 Ahmed I, Innes K, Brazzelli M, Gillies K, Newlands R, Avenell A, et al. Protocol for a randomised controlled trial comparing laparoscopic cholecystectomy with observation/conservative management for preventing recurrent symptoms and complications in adults with uncomplicated symptomatic gallstones (C-Gall trial). BMJ Open. 2021;11(3):e039781. https://doi.org/10.1136/bmjopen-2020-039781 https://doi.org/10.1136/bmjopen-2020-039...
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II B |
Laparoscopic cholecystectomy has a mortality rate of less than 0.2% and a morbidity rate of less than 5.0%66 Festi D, Reggiani ML, Attili AF, Loria P, Pazzi P, Scaioli E, et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol. 2010;25(4):719-24. https://doi.org/10.1111/j.1440-1746.2009.06146.x https://doi.org/10.1111/j.1440-1746.2009...
. Prophylactic cholecystectomy performed electively is associated with lower morbidity and mortality than when the surgery is emergency66 Festi D, Reggiani ML, Attili AF, Loria P, Pazzi P, Scaioli E, et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol. 2010;25(4):719-24. https://doi.org/10.1111/j.1440-1746.2009.06146.x https://doi.org/10.1111/j.1440-1746.2009...
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After laparoscopic cholecystectomy, 9% of asymptomatic patients before surgery developed biliary-type pain after surgery; 27.3% of those with mild symptoms before surgery persisted with these symptoms after the procedure; 14.1% of patients with severe symptoms persisted with symptoms after surgery, although four of them evolved with decreased intensity66 Festi D, Reggiani ML, Attili AF, Loria P, Pazzi P, Scaioli E, et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol. 2010;25(4):719-24. https://doi.org/10.1111/j.1440-1746.2009.06146.x https://doi.org/10.1111/j.1440-1746.2009...
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22% of previously asymptomatic patients developed symptoms during the follow-up period, but these disappeared in 58% and 52%, respectively, when they were mild and intense66 Festi D, Reggiani ML, Attili AF, Loria P, Pazzi P, Scaioli E, et al. Natural history of gallstone disease: Expectant management or active treatment? Results from a population-based cohort study. J Gastroenterol Hepatol. 2010;25(4):719-24. https://doi.org/10.1111/j.1440-1746.2009.06146.x https://doi.org/10.1111/j.1440-1746.2009...
. 1 to 4% of AC cases become symptomatic annually, reaching 20% in 20 years, and almost always had symptoms before a complication set in2121 Nascimento JHFD, Tomaz SC, Souza-Filho BM, Vieira ATS, Andrade AB, Gusmão-Cunha A. A population study on gender and ethnicity differences in gallbladder disease in Brazil. Arq Bras Cir Dig. 2022;35:e1652. https://doi.org/10.1590/0102-672020210002e1652 https://doi.org/10.1590/0102-67202021000...
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III A |
Prophylactic cholecystectomy after heart transplantation is recommended because it reduces mortality and costs, according to a quality-adjusted life-year assessment44 Choi SY, Kim TS, Kim HJ, Park JH, Park DI, Cho YK, et al. Is it necessary to peorm prophylactic cholecystectomy for asymptomatic subjects with gallbladder polyps and gallstones? J Gastroenterol Hepatol. 2010;25(6):1099-104. https://doi.org/10.1111/j.1440-1746.2010.06288.x https://doi.org/10.1111/j.1440-1746.2010...
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Emergency cholecystectomy in post-transplant recipients is associated with significantly higher morbidity and mortality, respectively: 44 and 37% in heart transplant recipients; 33 and 5.6% in kidney transplant recipients44 Choi SY, Kim TS, Kim HJ, Park JH, Park DI, Cho YK, et al. Is it necessary to peorm prophylactic cholecystectomy for asymptomatic subjects with gallbladder polyps and gallstones? J Gastroenterol Hepatol. 2010;25(6):1099-104. https://doi.org/10.1111/j.1440-1746.2010.06288.x https://doi.org/10.1111/j.1440-1746.2010...
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In cases of pancreas or kidney transplantation, the management of AC is recommended to be conservative since there has been no increase in AC-related morbidity in the post-transplant period44 Choi SY, Kim TS, Kim HJ, Park JH, Park DI, Cho YK, et al. Is it necessary to peorm prophylactic cholecystectomy for asymptomatic subjects with gallbladder polyps and gallstones? J Gastroenterol Hepatol. 2010;25(6):1099-104. https://doi.org/10.1111/j.1440-1746.2010.06288.x https://doi.org/10.1111/j.1440-1746.2010...
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III B |
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During their lifetime, 25 to 33% of patients with AC develop symptoms or complications related to the disease1515 Kim SB, Kim KH, Kim TN, Heo J, Jung MK, Cho CM, et al. Sex differences in prevalence and risk factors of asymptomatic cholelithiasis in Korean health screening examinee: A retrospective analysis of a multicenter study. Medicine (Baltimore). 2017;96(13):e6477. https://doi.org/10.1097/MD.0000000000006477 https://doi.org/10.1097/MD.0000000000006...
. In patients with AC, the rate of acute cholecystitis at 5-year follow-up was significantly higher in patients with coronary artery disease (CAD) (10.9%) compared to those without CAD (1.6%)1515 Kim SB, Kim KH, Kim TN, Heo J, Jung MK, Cho CM, et al. Sex differences in prevalence and risk factors of asymptomatic cholelithiasis in Korean health screening examinee: A retrospective analysis of a multicenter study. Medicine (Baltimore). 2017;96(13):e6477. https://doi.org/10.1097/MD.0000000000006477 https://doi.org/10.1097/MD.0000000000006...
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IV C |
Asymptomatic biliary microlithiasis is present in 74% of cases of acute idiopathic pancreatitis, and prophylactic cholecystectomy would eliminate the possibility of recurrence of pancreatitis2222 Pineda O, Maydón HG, Amado M, Sepúlveda EM, Guilbert L, Espinosa O, et al. A prospective study of the conservative management of asymptomatic preoperative and postoperative gallbladder disease in bariatric surgery. Obes Surg. 2017;27(1):148-53. https://doi.org/10.1007/s11695-016-2264-3 https://doi.org/10.1007/s11695-016-2264-...
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Cholecystectomy concomitant to bariatric surgery had higher morbidity and mortality rates (higher occurrence of infections, pulmonary and gastrointestinal complications), more re-interventions, and longer hospital stays compared to bariatric surgery without cholecystectomy2020 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. https://doi.org/10.1186/2046-4053-4-1 https://doi.org/10.1186/2046-4053-4-1...
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Few patients with AC after bariatric surgery developed gallstone symptoms in the first 12 months of postoperative follow-up. The overall rate of cholecystectomy when the patient became symptomatic or developed a complication 12 months after bariatric surgery was 3.4%2020 Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4(1):1. https://doi.org/10.1186/2046-4053-4-1 https://doi.org/10.1186/2046-4053-4-1...
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V D |
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Cirrhotic patients have higher mortality rates when undergoing surgery and anesthesia (overall mortality rate of 11.6%) and even higher in those with Child-Pugh C liver function (mortality rate of 17%)2323 Quintana JM, Cabriada J, Aróstegui I, Oribe V, Perdigo L, Varona M, et al. Health-related quality of life and appropriateness of cholecystectomy. Ann Surg. 2005;241(1):110-8. https://doi.org/10.1097/01.sla.0000149302.32675.22 https://doi.org/10.1097/01.sla.000014930...
. The morbidity rate for cirrhotic patients after laparoscopic cholecystectomy is higher (21% of cases)2323 Quintana JM, Cabriada J, Aróstegui I, Oribe V, Perdigo L, Varona M, et al. Health-related quality of life and appropriateness of cholecystectomy. Ann Surg. 2005;241(1):110-8. https://doi.org/10.1097/01.sla.0000149302.32675.22 https://doi.org/10.1097/01.sla.000014930...
. Cirrhotic patients have a higher conversion rate from laparoscopic to open surgery2323 Quintana JM, Cabriada J, Aróstegui I, Oribe V, Perdigo L, Varona M, et al. Health-related quality of life and appropriateness of cholecystectomy. Ann Surg. 2005;241(1):110-8. https://doi.org/10.1097/01.sla.0000149302.32675.22 https://doi.org/10.1097/01.sla.000014930...
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When symptoms appear, morbidity and mortality are higher in patients with cirrhosis compared to non-cirrhotic patients2323 Quintana JM, Cabriada J, Aróstegui I, Oribe V, Perdigo L, Varona M, et al. Health-related quality of life and appropriateness of cholecystectomy. Ann Surg. 2005;241(1):110-8. https://doi.org/10.1097/01.sla.0000149302.32675.22 https://doi.org/10.1097/01.sla.000014930...
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