LONG-TERM EVOLUTION OF ASYMPTOMATIC CHOLELITHIASIS DIAGNOSED DURING ABDOMINAL OPERATIONS FOR VARICEAL BLEEDING IN PATIENTS WITH CIRRHOSIS

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.