Uncomplicated gallstones: who should be operated on?

Gallstones are common and occur asymptomatically or symptomatically with or without complications. Treatment is only required for symptomatic gallstones and complications in gallstones. Laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones and is performed with an increasing frequency. One may fear, that the indications for cholecystectomy have changed, and surgery is now undertaken for a lesser degree of morbidity. Cholecystectomy does not increase life expectancy, and 20-30% of patients cholecystectomized for symptomatic gallstones complain of abdominal pain of unknown origin after the operation. New valid parameters in order to predict which patients will benefit from cholecystectomy are therefore necessary. Symptoms specific to gallstones are not precisely known, and greatest success in treatment seems to be related to the occurrence of severe, often steady pain, of hours' duration, often located in the epigastrium or upper right quadrant, with or without radiation and/or vomiting. Dyspepsia alone is not an indication for cholecystectomy. Psychological vulnerability may predict a poor outcome after cholecystectomy and should lead to reconsideration of the indication for surgery.