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Asian journal of endoscopic surgery
Apr, 2024;17 (2): e13297.

An Indian surgeon's perspective on management of asymptomatic gallstones.

Sargun Virk, Harshit Arora, Priti Patil, Bhakti Sarang, Monty Khajanchi, Lovenish Bains, Deepa Veetil Kizhakke, Samarvir Jain, Priyansh Nathani, Ya Dev, Anita Gadgil, Nobhojit Roy
Author Information
  1. Sargun Virk: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  2. Harshit Arora: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India. ORCID
  3. Priti Patil: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  4. Bhakti Sarang: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  5. Monty Khajanchi: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  6. Lovenish Bains: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  7. Deepa Veetil Kizhakke: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  8. Samarvir Jain: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  9. Priyansh Nathani: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  10. Ya Dev: Department of Surgery, Government Medical College, Trivandrum, India.
  11. Anita Gadgil: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
  12. Nobhojit Roy: Department of General Surgery, World Health Organization Collaborating Centre for Research in Surgical Care Delivery in LMICs, Mumbai, Maharashtra, India.
PMID: 38439130 DOI: 10.1111/ases.13297

Abstract

INTRODUCTION: Cholelithiasis is widely prevalent in India, with a majority of patients being asymptomatic while a small proportion experiencing mild complications. In the laparoscopic era, the rate of cholecystectomies has increased owing to early recovery and fewer complications. In asymptomatic patients, the risk of complications must be balanced against the treatment benefit. Recent guidelines suggest no prophylactic cholecystectomy in asymptomatic patients. We aimed to find out the Indian surgeons' perspective on asymptomatic gallstone management.
METHODS: A cross-sectional e-survey was conducted of practicing surgeons, onco-surgeons and gastrointestinal-surgeons in India. The survey had questions regarding their perspective on laparoscopic cholecystectomy and treatment modalities in asymptomatic gallstones.
RESULTS: A total of 196 surgeons responded to the survey. Their mean age was 42.3 years. Overall, 111 (57%) respondents worked in the private sector. Most surgeons (164) agreed that the rate of cholecystectomy has increased since the advent of laparoscopy; 137 (70%) respondents agreed that they would not operate on patients without risk factors. Common bile duct stones, chronic hemolytic diseases, transplant recipients, and diabetes mellitus were the risk factors. Majority of the participants agreed on not performing a cholecystectomy in patients with asymptomatic gallstones.
CONCLUSION: There exists a lack of consensus among Indian surgeons on asymptomatic gallstone management in India. Where the majority of cases are asymptomatic and do not require surgery, certain comorbidities can influence the line of treatment in individual patients. Currently, the treatment guidelines for asymptomatic patients need to be established as cholecystectomies may be overperformed due to the fear of development of complications.

Keywords

asymptomatic cholelithiasis asymptomatic gallstones prophylactic cholecystectomy

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MeSH Term

Humans
Adult
Gallstones
Cross-Sectional Studies
Risk Factors
Cholecystectomy
Surgeons
Journal Article

Word Cloud

Created with Highcharts 10.0.0asymptomaticpatientscholecystectomycomplicationstreatmentsurgeonsgallstonesIndiariskIndianperspectivemanagementagreedmajoritylaparoscopicratecholecystectomiesincreasedguidelinesprophylacticgallstonesurveyrespondentsfactorsINTRODUCTION:CholelithiasiswidelyprevalentsmallproportionexperiencingmilderaowingearlyrecoveryfewermustbalancedbenefitRecentsuggestaimedfindsurgeons'METHODS:cross-sectionale-surveyconductedpracticingonco-surgeonsgastrointestinal-surgeonsquestionsregardingmodalitiesRESULTS:total196respondedmeanage423 yearsOverall11157%workedprivatesector164sinceadventlaparoscopy13770%operatewithoutCommonbileductstoneschronichemolyticdiseasestransplantrecipientsdiabetesmellitusMajorityparticipantsperformingCONCLUSION:existslackconsensusamongcasesrequiresurgerycertaincomorbiditiescaninfluencelineindividualCurrentlyneedestablishedmayoverperformedduefeardevelopmentsurgeon'scholelithiasis

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