Asymptomatic gallstone disease: Re-evaluating the threshold for surgical options in the era of precision medicine

Table 1 Elective cholecystectomy vs expectant management in asymptomatic gallstone disease

Parameter	Prophylactic surgery	Expectant management
Risk of complications	Low when elective; increases in elderly/comorbid patients	Low initially; increases with time in high-risk patients
Clinical risk	Large solitary stone; ≥ 10 mm polyp/rapid growth, calcified non-functioning gall bladder, haemolysis, immunosuppression	Small stones without high-risk features; low comorbidity; reliable access to urgent care
Quality of life impact	Can be improved in symptomatic or high-risk patients	Stable; may decrease if complications
Risk of gallbladder cancer	Lower in selected high-risk groups (e.g., solitary large stones)	Higher in endemic areas with large stones or familial risk
Cost-effectiveness	More cost-effective in high-risk, elderly patients	More cost-saving in young, low-risk patients with very good follow-up
Postoperative complications	Bile duct injury, diarrhoea, dyspepsia (1%-5%), possible	None at first, but the danger of emergency surgery complications