Patients with asymptomatic course of cholelithiasis, assessment of risk factors for complications and selection of patient groups for surgical treatment

The article reviews works on the treatment of patients with asymptomatic cholelithiasis. Cholelithiasis is common in 10-13% of the population, but only 13-22% develop symptoms of the disease and complications. The article examines how views on the problem of treatment of cholelithiasis have been changing with the introduction of new technologies: ultrasound examination of the abdominal cavity, which made it possible to identify a significant number of patients with cholelithiasis. The introduction of laparoscopic cholecystectomy significantly facilitated surgical treatment for the patient and allowed to expand the indications for cholecystectomy.At the moment, there are different points of view on the need for surgical treatment of cholelithiasis. Some consider that cholecystomy is the only method of treating patients with cholelithiasis. However, most authors believe that in asymptomatic cholelithiasis, a wait-and-see tactic is more justified, and even extend this tactic to patients with a previous episode of cholecystitis.Among asymptomatic patients with cholelithiasis, there are groups of patients with a high risk of complications for whom surgical treatment is justified: Porcelain gallbladder, macro- and micro-lithiasis, multiple gallstones, disconnected gallbladder, hemolytic anemia. Besides, the necessity of cholecystectomy in patients with gallstones undergoing surgery on abdominal organs for another disease is also being discussed.Dividing patients with asymptomatic cholelithiasis into those for whom surgical treatment is preferable and those who are sufficiently monitored will reduce the number of complications of cholelithiasis and reduce the burden on Healthcare. However further clinical studies are needed to determine the treatment tactics for some groups of patients.