H. Orozco et al., LONG-TERM EVOLUTION OF ASYMPTOMATIC CHOLELITHIASIS DIAGNOSED DURING ABDOMINAL OPERATIONS FOR VARICEAL BLEEDING IN PATIENTS WITH CIRRHOSIS, The American journal of surgery, 168(3), 1994, pp. 232-234
To define the risk of complications in cirrhotic patients with asympto
matic cholelithiasis and the possible benefit of incidental cholecyste
ctomy during abdominal operations in these patients, a retrospective c
ohort of cirrhotic patients who had asymptomatic cholelithiasis and un
derwent abdominal operations for portal hypertension was analyzed. Of
338 patients operated on during the last 15 years, 34 patients were fo
und with asymptomatic cholelithiasis, all of whom had long-term follow
-up. At a mean follow-up of 70.5 +/- 8.6 months (SEM), 28 patients rem
ained asymptomatic (82%), 6 patients have developed symptoms (18%), (4
patients had acute cholecystitis and 2 chronic cholecystitis), and 3
of these patients (8.8%) died due to complications of acute cholecysti
tis. The results suggest that the risk for the development of complica
tions is low but that the mortality associated with acute episodes of
cholecystitis is high. Incidental cholecystectomy is not justified in
cirrhotic patients with asymptomatic cholelithiasis, but close follow-
up with early elective operation when symptoms supervene should be rec
ommended.