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Abstract Prophylactic cholecystectomy for asymptomatic cholelithiasis can be justified in certain circumstances, such as in patients with sickle cell disease, those undergoing open bariatric surgery, requiring long-term total parental nutrition, or patients who are therapeutically immune-suppressed after solid organ transplantation. Patients with sickle cell disease often have hepatic or vaso-occlusive crises that can be difficult to differentiate from acute cholecystitis. In patients following bariatric surgery, the development of gallstones is markedly increased during the period of rapid weight loss to an incidence of about 30%.A considerable percentage of these patients develop symptomatic cholelithiasis requiring cholecystectomy. (53, 54) However, the surgeon must also be facile with open biliary surgery for several reasons. First, the conversion rate to OC remains approximately 2–5% in most series. This is more common in the elderly and in the setting of acute cholecystitis. In these situations cholecystectomy will be more difficult and therefore experience and proper care are necessary to avoid technical errors that could lead to devastating complications. Secondly, there are specific instances when open surgery should be considered a wiser approach. (55) |