"Silent" Gallstones

Arch Surg. 1962;85(2):338-344. doi:10.1001/archsurg.1962.01310020168030.
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Most physicians agree that cholecystectomy is the treatment of choice in the definitive care of symptomatic cholelithiasis. Opinions differ, however, regarding the indications for prophylactic cholecystectomy in the patient who has "silent" gallstones, with some physicians believing that the symptomless gallstone or stones should be left alone. They base their opinion on extensive autopsy studies which have shown gallstones present in 20% to 40% of all patients over 60 years of age.10,13,14,17 Another equally vociferous group believe that the symptomless gallstone or stones do present many dangers.4,6,8,11,15,16,19,22 Moore et al.18 concluded from a review of the literature that, in patients with asymptomatic stones, eventually 50% would develop symptoms and within this group 10%-15% would develop severe to critical biliary tract complications. In 1948, Comfort, Gray, and Wilson8 reported a 10-20 year follow-up of 112 patients who had left the Mayo Clinic carrying "silent" stones discovered


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