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.