Recommendations of the Chinese Society of Medical Surgery on the treatment of benign gallbladder disease.
Recommendation 1: Treatment of benign gallbladder disease should be integrated with the presence or absence of symptoms, the presence or absence of gallbladder function, the presence or absence of inflammation, the presence or absence of complications and the availability of conditions for surgical implementation to develop an individualized treatment strategy.
Recommendation 2: Cholecystectomy is the standard treatment procedure for benign gallbladder disease, and laparoscopic cholecystectomy should be the first choice.
Recommendation 3: Cholecyst drainage is an effective treatment for patients with critical acute cholecystitis, and PTGBD should be preferred.
Recommendation 4: The practical value of cholecystolithotomy needs further study, and it is currently only appropriate for emergency treatment under acute conditions and not as a recommended procedure for elective surgery.
Recommendation 5: Pharmacological lithotripsy, lithotripsy, and extracorporeal shock wave lithotripsy have low cure rates and have side effects that lead to serious complications, and are not recommended for clinical use at this time.
Recommendation 6: Patients with asymptomatic and mildly symptomatic gallbladder stones do not require routine prophylactic cholecystectomy.
Recommendation 7: Prophylactic cholecystectomy may be an option for elderly patients who expect that treatment may significantly increase the risk of surgery.
Recommendation 8: Elective cholecystectomy should be performed in patients with gallbladder stones whose symptoms significantly affect work or life or who have had previous episodes of biliary colic, acute cholecystitis, or biliary pancreatitis.
Recommendation 9: Patients with gallbladder stones with high risk factors for gallbladder cancer or suspected gallbladder cancer should be operated regardless of the presence of symptoms.
Recommendation 10: Patients admitted to the hospital in an emergency for cholecystitis should have cholecystectomy performed during the initial hospitalization when possible, taking into account the patient’s general condition.
Recommendation 11: Surgery should be performed as early as possible for mild acute cholecystitis, and LC is preferred in patients without contraindications to laparoscopic surgery.
Recommendation 12: For moderate or severe acute cholecystitis with onset >72h, with complications such as gallbladder gangrene or perforation, secondary limited or diffuse peritonitis, or sepsis, emergency cholecystectomy should be chosen. Patients who are not suitable for emergency surgery conditions can be operated electively by PTGBD, after the acute inflammation has resolved.
Recommendation 13: Gallbladder polyp-like lesions should be carefully identified based on the ultrasound imaging presentation of the lesion, combined with the patient’s age, size and location of the lesion and the presence of concomitant gallbladder stones and other clinicopathological features.
Recommendation 14: Patients with cholesterol polyps without obvious symptoms can be observed at regular follow-up intervals of 6 to 12 months. Cholecystectomy may be an option if there are symptoms that significantly affect the patient’s daily work and life or secondary complications such as acute cholecystitis.
Recommendation 15: In patients with benign non-cholesterol polyp-like lesions, cholecystectomy may be chosen if there are symptoms that significantly affect the patient’s daily work and life or if the diameter of the single lesion is >10 mm.
Recommendation 16: Patients with suspected polypoid early-stage gallbladder cancer or rapidly increasing lesions should undergo cholecystectomy for a limited period of time.
Recommendation 17: Patients with acute non-stony cholecystitis should undergo immediate PTGBD or cholecystectomy in conjunction with the patient’s systemic condition.
Recommendation 18: Chronic non-lithiatic cholecystitis that is not symptomatic can be treated conservatively under close observation. For patients with significant symptoms and clear pathological changes, elective surgery can be performed.
Recommendation 19: Gallbladder dysfunction should be diagnosed with caution, and if the diagnosis is clear and the symptoms are obvious, the gallbladder can be electively surgically removed.