Choosing Wisely:

Avoid routine cholecystectomy for patients with asymptomatic cholelithiasis.

Rationale and Comments: 10% to 20% of people in Western countries have gallstones and 50% to 70% of these are asymptomatic. Incidental discovery of gallstones on imaging performed for unrelated reasons is common, often prompting surgical consultation. Treatment with observation alone is indicated for asymptomatic patients with incidental cholelithiasis, unless diagnosed with related hematologic disease. Cholecystectomy for patients with asymptomatic cholelithiasis is too aggressive. For patients with asymptomatic cholelithiasis who are undergoing an unrelated abdominal operation, such as gastric bypass, concomitant cholecystectomy may be considered.
Sponsoring Organizations:
  • Society of American Gastrointestinal and Endoscopic Surgeons
  • Sources:
  • Society of American Gastrointestinal and Endoscopic Surgeons guideline
  • Disciplines:
  • Gastroenterologic
  • Surgical
  • References: • SAGES guideline for the application of laparoscopic biliary tract surgery. Available at
    • Sakorafas GH, et al: Dig Dis Sci 2007 May;52(5)1313-25.
    • Williams CI, et al: Current Treatment Options in Gastroenterology 11(2)71-77.

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