Policy Number: SRP 051
Policy Name: Gall Stones/Cholecystectomy
Status: Group Prior Approval
Effective Date: 1 April 2024
Next Review Date: 1 April 2026
Mid and South Essex ICB commissions cholecystectomy on a restricted basis.
Cholecystectomy is routinely commissioned for symptomatic gallstones as a day‑case laparoscopic cholecystectomy for people having it as an elective planned procedure unless their circumstances or clinical condition make an inpatient stay necessary.
MSE ICB does not routinely fund cholecystectomy for asymptomatic gallstones because the risks of surgery outweigh the benefits. Asymptomatic gallstones are defined as the presence of gallstones detected incidentally in patients who do not have any abdominal symptoms or have symptoms that are not thought to be due to gallstones.
The following tables indicate appropriateness of indication versus risk due to patient co-morbidity.
Indications for cholecystectomy:
| Indication | Investigative Findings | Comorbidity |
|---|---|---|
| Vague Symptoms | Stone in CBD | No+low |
| Single attack of biliary colic | Stone(s) in GB or CBD or non-functioning GB | No+low |
| Multiple attacks of biliary colic | Stone(s) in GB or CBD or non-functioning GB | No+low |
| Confirmed acute cholecystitis | Stone(s) in GB or CBD or non-functioning GB | No+low |
| Suspected acute cholecystitis | Stone(s) in GB or CBD | No+low |
| Porcelain gall bladder | Stone(s) in GB or CBD | No |
| Silent onset of jaundice | Stone in CBD or dilated CBD | No+low |
| Acute pancreatitis with and without appreciable alcohol intake | Stone(s) in GB or CBD | No+low |
| Acute recurrent pancreatitis – no significant alcohol intake | Stone(s) in GB or CBD | No, low +med |
| Acute recurrent pancreatitis – appreciable alcohol intake | Stone in CBD | No+low |
| Incidental cholecystectomy + compatible symptoms | No+low |
Inappropriate Indications for cholecystectomy:
| Indication | Investigative Findings | Comorbidity |
|---|---|---|
| Vague Symptoms | Stone in GB or chronic cholecystitis Any | Med + high High |
| Single attack of biliary colic | Stone(s) in GB or non-functioning GB | High |
| Suspected acute cholecystitis | No Stones Stones but no complications | High High |
| Porcelain gall bladder | High | |
| Silent onset of jaundice | No Stones Stones in GB only Stone in CBD only | All Low + med High |
| Acute pancreatitis with and without appreciable alcohol intake | No Stones Stones in GB only | All High |
| Acute recurrent pancreatitis – no significant alcohol intake | No Stones | Med+high |
| Acute recurrent pancreatitis – appreciable alcohol intake | No Stones Stones in GB only | All High |
| Incidental cholecystectomy + Asymptomatic | Med + high | |
| Long term TPN | Symptoms only Stones only Symptoms + stones Incidental findings | Med + high Med + high High Med + high |
| Asymptomatic cholecyternteric fistula | Med+high |
Exceptions to this policy could include patients with asymptomatic gallstones and
- Sickle cell disease.
- Calcified ‘porcelain’ gallbladder or a family history of gallbladder carcinoma immunosuppression, as they would be at higher risk if they develop an infective complication i.e. cholecystitis or cholangitis.
Patients not meeting the above criteria will not be funded unless there are clinically exceptional circumstances.
Individual funding requests should only be made where the patient demonstrates clinical exceptionality.
Find out more information on applying for funding in exceptional clinical circumstances