الفهرس 
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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)