Palpation of the gall bladder at the time of laparotomy performed for intra-abdominal disease unrelated to the biliary tract has revealed the unexpected presence of gallstones in an impressive number of patients more than 40 years of age. The problem as to what course should be followed in these cases remains a serious one for the surgeon. Should the gall bladder which contains the "silent" stones be removed forthwith, in spite of the risk from a second major procedure? Or should cholecystectomy be postponed, thereby subjecting the patient to the chance of acute cholecystitis developing in the postoperative period, when the diagnosis might be masked by the effect of narcotics or the condition confused with other less serious complications? In other words, is watchful waiting justifiable?
Answers to this question, which has just been stated in two ways, represent a wide variety of opinions. In 1948, Comfort, Gray,