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This review examines the evidence currently available upon which such decisions must be based. Gallstones may present as biliary pain, acute cholecystitis, biliary obstruction or pancreatitis, but it is not clear who will develop symptoms and what are the commonest initial symptoms. Studies of the natural history of silent gallstones suggest that a large majority of patients with such stones will remain asymptomatic. However, diabetics are at increased risk, as are patients whose stones are detected initially at laparotomy. Incidental cholecystectomy is usually safe, and preoperative detection by ultrasonic screening is an advantage in planning the operation. Prophylactic cholecystectomy is not indicated to prevent gallbladder carcinoma (except in cases of porcelain gallbladder) and there is conflicting evidence about whether cholecystectomy predisposes to colorectal carcinoma.<\/jats:p>","DOI":"10.1002\/bjs.1800770405","type":"journal-article","created":{"date-parts":[[2007,3,3]],"date-time":"2007-03-03T13:58:05Z","timestamp":1172930285000},"page":"368-372","source":"Crossref","is-referenced-by-count":104,"title":["Asymptomatic gallstones"],"prefix":"10.1093","volume":"77","author":[{"given":"E J","family":"Gibney","sequence":"first","affiliation":[{"name":"Department of Surgery, Beaumont Hospital , Dublin 9,","place":["Ireland"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1990,4,1]]},"reference":[{"key":"2024092808022613000_bib1","doi-asserted-by":"crossref","first-page":"865","DOI":"10.1016\/S0039-6109(16)42484-9","article-title":"Current status of medical treatment of gallstones","volume":"61","author":"Pimstone","year":"1981","journal-title":"Surg Clin North Am"},{"key":"2024092808022613000_bib2","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1056\/NEJM198501243120406","article-title":"Rapid dissolution of gallstones by methyl tert-butyl ether","volume":"312","author":"Allen","year":"1985","journal-title":"N Engl J Med"},{"key":"2024092808022613000_bib3","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1056\/NEJM198603273141304","article-title":"Fragmentation of gallstones by extracorporeal shock waves","volume":"314","author":"Sauerbruch","year":"1986","journal-title":"N Engl J Med"},{"key":"2024092808022613000_bib4","first-page":"401","article-title":"Biliary tract disease","volume":"153","author":"Glenn","year":"1981","journal-title":"Surg Gynecol Obstet"},{"key":"2024092808022613000_bib5","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1136\/bmj.298.6667.133","article-title":"Cholecystectomy for gallstones","volume":"298","author":"Finlayson","year":"1989","journal-title":"Br Med J"},{"key":"2024092808022613000_bib6","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1056\/NEJM198209233071305","article-title":"The natural history of silent gallstones","volume":"307","author":"Grade","year":"1982","journal-title":"N Engl J Med"},{"key":"2024092808022613000_bib7","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/00000658-198507000-00009","article-title":"The natural history of diagnosed gallstone disease in symptomatic and asymptomatic patients","volume":"202","author":"McSherry","year":"1985","journal-title":"Ann Surg"},{"key":"2024092808022613000_bib8","first-page":"495","volume-title":"Current Surgical Diagnosis and Treatment","author":"Way","year":"1988"},{"key":"2024092808022613000_bib9","first-page":"350","article-title":"Should cholecystectomy be done en passant for asymptomatic cholelithiasis?","volume":"30","author":"Saade","year":"1987","journal-title":"Can J Surg"},{"key":"2024092808022613000_bib10","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1097\/00000658-196002000-00001","article-title":"Surgical indications in cholelithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow up on 526 nonoperated cases","volume":"151","author":"Lund","year":"1960","journal-title":"Ann Surg"},{"key":"2024092808022613000_bib11","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1097\/00000658-198102000-00022","article-title":"Silent gallstones","volume":"193","author":"Glenn","year":"1981","journal-title":"Ann Surg"},{"key":"2024092808022613000_bib12","first-page":"429","article-title":"Controversies in biliary tract surgery","volume":"29","author":"Pickleman","year":"1986","journal-title":"Can J Surg"},{"key":"2024092808022613000_bib13","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1056\/NEJM198209233071309","article-title":"Advice for the patient with \u2018silent\u2019 gallstones","volume":"307","author":"Donaldson","year":"1982","journal-title":"N Engl J Med"},{"key":"2024092808022613000_bib14","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1136\/gut.25.10.1029","article-title":"Gallstones and mortality: a study of all gallstone related deaths in a single health district","volume":"25","author":"Godrey","year":"1984","journal-title":"Gut"},{"key":"2024092808022613000_bib15","doi-asserted-by":"crossref","first-page":"1147","DOI":"10.1056\/NEJM197605202942103","article-title":"Gallbladder disease. 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