The number of laparoscopic cholecystectomies in the Netherlands has increased significantly in recent years. However, there is a large variation in practice. This is a sign of inefficient use of cholecystectomy. Cholecystectomy is the treatment of choice in patients with uncomplicated symptomatic gallstones, but 30% of the patients has persistent pain after surgery. In a large prospective multicentre randomised trial, a restrictive strategy was compared to usual care in patients with symptomatic gallstones. The results show suboptimal pain reduction in both groups. There were fewer cholecystectomies in the restrictive strategy group and no difference in gallstone related complications between the groups. It is therefore still unclear which patients with gallstones and abdominal symptoms should undergo cholecystectomy. The data could be used in new studies to construct algorithms for patient selection. In the meantime, the use of a decision aid is recommended. Well-informed patients can, in consultation with their doctors, opt for cholecystectomy or a conservative approach. This strategy will lead to fewer unnecessary cholecystectomies.