Surgical cholecystostomy is performed often at our institution for emergent management of acute calculous cholecystitis in high-risk elderly patients. Gallstones are removed either during surgery or by subsequent radiologic manipulation. Most such patients do not undergo subsequent cholecystectomy. The frequency of gallbladder stone and/or biliary symptom recurrence was studied in 63 patients who had undergone successful cholecystolithotomy. Follow-up examinations in 48 of these patients, performed at a mean of 18 +/- 12 months after surgery, showed recurrence of gallstones in 13 patients (27%). This included 12 of 38 patients who had follow-up sonograms and one of two cadavers that underwent autopsy. None of eight patients who had a subsequent cholecystectomy had recurrent stones. Two of 17 patients studied within 1 year of cholecystolithotomy had recurrent calculi, as did six of 21 patients studied at 1-2 years, four of five patients studied at 2-3 years, and one of five patients studied at 3-4 years. Biliary symptoms were assessed in 46 of the 48 patients who had follow-up examinations (two patients died) and in the 15 other patients who had undergone successful cholecystolithotomy. Recurrent or residual symptoms were present in seven (11%) of 61 patients, including three of the 13 patients with recurrent calculi. Six of these seven patients underwent further hospital treatment. These results confirm the anticipated high frequency of stone recurrence after cholecystolithotomy. However, because most patients with recurrent stones were asymptomatic, routine interval cholecystectomy may not be necessary.