Conveniencia de la colecistectomia laparoscópica en el paciente con litiasis asintomática / Suitability of laparoscopic cholecistectomy in the asymptomatic cholelithiasis patient

RESUMO

Cholelithiasis is a disease of high prevalence in the adult population. Prevalence increases with age; the incidence of complications, such as choledocolithiasis, acute pancreatitis, and cancer of galbladder, also increase with age. Cholecystectomy has been considered as the gold standard in the treatment of symptomatic or complicated cholethiasis. Laparoscopic cholecystectomy has become the new gold standard. Our Department of Surgery has adopeted a policy of advising laparoscopic cholecistectomy in all patiens with symptomatic cholelithiasis, but also subpopulation of high risk asymptomatic patients. This subgroup is made up by patients with long life expectancy, radioopaque stones, small calculus with patent cystic duct, nonfunctioning or calcified gall bladder, and patients with concomitant diabetes, cirrhosis, chronic hemolytic anemia, those are candidates for kidney or heart transplantation, and those with underling degenerative diseases that are more likely to develop severe complication of of choletihiasis. Csendes of Chile has reported very high incidence of gallbladder cancer in Chile and Bolivia. He considers that cholecystectomy is indicated in asymptomatic patients as a "prophylactic" measure. Our group agrees that this is a valid indication in areas or populations groups where gallbladder cancer is of high prevalence.