Policy Category: INNF Who usually applies for funding? GP/Cons Asymptomatic Gallstones Commissioning decision Cholecystectomy for asymptomatic gallstones is considered a low priority for funding and will only be considered in exceptional circumstances. Funding approval must be sought from the CCG via the Individual Funding Request process prior to treatment. Policy Statement: Gloucestershire Clinical Commissioning Group will not normally fund cholecystectomy for asymptomatic gallstones. Asymptomatic gallstones are gallstones detected incidentally in patient who do not have any abdominal symptoms or have symptoms that are not thought to be due to gallstones. Rationale: Cholecystectomy is the surgical removal of the gall bladder. Prophylactic cholecystectomy due to the presence of asymptomatic gallstones is not generally indicated. Plain English Summary: Surgical removal of the gallbladder is one of the most common operations performed by the NHS. More than 60,000 gallbladder removals are performed each year. The medical term for gallbladder removal is cholecystectomy. The gallbladder is a small, pear-shaped pouch in the upper right part of your abdomen (tummy). It stores bile, the digestive fluid produced by the liver that helps to break down fatty foods. Bile is made from cholesterol, bile salts and waste products. When these substances are out of balance, small, hard stones called gallstones can form. Gallstones often cause no symptoms and in many cases remain undetected. Gallstones may be identified incidentally during investigations for other symptoms. Where this is the case and the gallstones are not causing any symptoms there is no need for surgical intervention to remove the gallbladder Evidence base: Afdhal N. Approach to the patient with incidental gallstones. UpToDate July 2006. Available at: http://www.utdol.com/utd/content/topic Meshikhes A. Asymptomatic Gallstones in the Laparoscopic Era. J.R. College of Surgery, Edinburg. December 2002 742-748. Available at www.rcsed.ac.uk/journal/vol47_6/47600004.html Gurusamy KS, Samraj K. Cholecystectomy for patients with silent gallstones. Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD006230. DOI: 1 Policy Category: INNF Who usually applies for funding? GP/Cons 10.1002/14651858.CD006230.pub2. McAlister V, Davenport E, Renouf E. Cholecystectomy deferral in patients with endoscopic sphincterotomy. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD006233. DOI: 10.1002/14651858.CD006233.pub2. Similarity to other local CCG policies – Bristol, South Gloucestershire, Bath and North East Somerset. West Midlands. Link to application form – Individual Funding Request application form For further information please contact GLCCG.IFR@nhs.net Date of publication Policy review date 1st August 2015 June 2017 Consultation Consultee Planned Care Programme Board CCG Governing Body Development Session GHNHSFT (via General Manager/Head of Contracts) GP Membership (via CCG Live/What’s New This Week) Date 31st March 2015 (virtual) 4th June 2015 18/05/2015 – 29/05/2015 06/05/2015 – 05/06/2015 Has the consultation included patient representatives? No Policy sign off Reviewing Body Effective Clinical Commissioning Policy Group Integrated Governance and Quality Committee 2 Date of review 14th April 2015 18th June 2015