II. Epidemiology
- Laparoscopic Cholecystectomy is the most common abdominal surgery in Europe and U.S.
- Incidence: 750,000 per year in U.S. alone
III. Indications
- Biliary Colic
- Biliary Dyskinesia
- Calcified Gallbladder
-
Acute Cholecystitis
- Urgently perform within 72 hours of onset
-
Choledocholithiasis
- Perform after Common Bile Duct Stone is cleared with ERCP
-
Gallstone Pancreatitis
- Perform after Pancreatitis resolves, before hospital discharge
IV. Contraindications: Laparoscopic Cholecystectomy
- Gallbladder cancer (absolute contraindication)
- Uncontrolled Coagulopathy (absolute contraindication)
- Advanced Cirrhosis or liver failure
- Coagulopathy
- Peritonitis
- Sepsis
V. Advantages: Laparoscopic Cholecystectomy (preferred)
- Decreased pain and Disability
- Much earlier return to work time
- Shorter hospital stay (often outpatient)
- Lower mortality
- Laparoscopic: 8 to 16 per 10,000 patients
- Open: 66 to 74 per 10,000 patients
- Shea (1996) Ann Surg 224:609-20 [PubMed]
- Treatment cost slightly less than open Cholecystectomy
- Better cosmetic result
VI. Management: Timing of Surgery - Early surgery is safe and preferred
- Incidence of technical complications is the same
- Reduces total illness duration by 30 days
- Hospitalization time reduced by 5-7 days
- Direct medical cost savings reduced by > $2000
- Death rate slightly lower with early surgery
- References
VII. Management: Antibiotic prophylaxis
- Indications: Patients at high risk of Wound Infection
- Age over 60 years old
- Diabetes Mellitus
- Acute Biliary Colic within 30 days of surgery
- Jaundice
- Acute Cholecystitis
- Ascending Cholangitis
- Protocol
- Cefazolin 1 g IV within one hour of skin incision for one dose
- Continue other Antibiotics as indicated (e.g. Ascending Cholangitis)
- References
VIII. Complications
- Acute Perioperative
- Conversion from laparoscopy to open laparotomy (see below)
- Common Bile duct injury or Bile leak (see below)
- Retained or dropped Gallstone (<5%)
- Gallstone drops during resection into the peritoneum
- Results in infection, forming an abscess or phlegmon
- Other acute complications
- Perioperative Hemorrhage (abdominal wall or intra-abdominal in 3-4%)
- Surgical Wound Infection (0.9%)
- Incisional Hernia (0.4%)
- Chronic
- Postcholecystectomy Syndrome (see below)
IX. Complications: Conversion From Laparoscopy to Open Laparotomy
- Rates
- Uninflamed gallbladder: 2-15%
- Acute Cholecystitis: 6-35%
- Risk factors
- Male gender
- Over age 60 years
- History of upper abdominal surgery
- Ultrasound with thickened gallbladder wall
- Acute Cholecystitis
- References
X. Complications: Common Bile Duct Injury (Bile leak)
- Typically presents within 3 days of Laparoscopic Cholecystectomy
- Laparoscopic: 36 to 47 per 10,000 patients
- Open: 19 to 29 per 10,000 patients
- Shea (1996) Ann Surg 224:609-20 [PubMed]
- Diagnosis
- HIDA Scan
- Ultrasound will show a free fluid collection around the biliary duct
- ERCP: Dye extravasates
- Ultrasound guided needle aspiration will reveal brown bile (as opposed to post-operative Hematoma)
- References
- Weinstock in Herbert (2012) EM:RAP 12(3): 3
XI. Complications: Postcholecystectomy Syndrome
- May be associated with increased bile acid production
- Symptoms
- Bile-Acid Diarrhea (13% following Cholecystectomy)
- Abdominal Pain
- Bloating
- Dyspepsia
- Flatulence
- Management
- Spontaneously improves with time following Cholecystectomy
- Consider Cholestyramine
- References
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Related Studies
Definition (NCI) | Surgical removal of the gallbladder. |
Definition (MSH) | Surgical removal of the GALLBLADDER. |
Definition (CSP) | surgical removal of the gallbladder. |
Concepts | Therapeutic or Preventive Procedure (T061) |
MSH | D002763 |
ICD9 | 51.22, 51.2 |
ICD10 | 965 , 30443-00 |
SnomedCT | 149492003, 119917005, 174500005, 38102005 |
CPT | 47600, 1014153 |
LNC | LA14290-3, LA16844-5 |
English | Cholecystectomies, Cholecystectomy, CHOLECYSTECTOMY, Excision of gallbladder NOS, gallbladder removal, Cholecystectomy procedure, cholecystectomy (treatment), removal of gallbladder, cholecystectomy, cholecystectomies, cholecystectomy procedure, excision of gallbladder, surgical removal of the gallbladder, Excision of gallbladder NOS (procedure), Gallbladder removal, Removal of gallbladder, Excision of gallbladder, Cholecystectomy (procedure), Gallbladder excision, REMOVAL OF GALLBLADDER |
Japanese | 胆嚢切除, タンノウセツジョ |
Swedish | Gallblåseoperation |
Czech | cholecystektomie, Cholecystektomie |
Finnish | Kolekystektomia |
Russian | KHOLETSISTEKTOMIIA, ХОЛЕЦИСТЭКТОМИЯ |
Croatian | KOLECISTEKTOMIJA |
Polish | Cholecystektomia, Wycięcie pęcherzyka żółciowego |
Hungarian | Cholecystectomia |
Norwegian | Galleblærekirurgi, Galleblæreoperasjon, Kolecystektomi |
Spanish | escisión de la vesícula biliar, escisión de la vesícula biliar (concepto no activo), resección de vesícula biliar, SAI (procedimiento), resección de vesícula biliar, SAI, colecistectomía (procedimiento), colecistectomía, Colecistectomía |
Dutch | galblaasverwijdering, Cholecystectomie |
French | Cholécystectomie |
German | Cholezystektomie |
Italian | Colecistectomia |
Portuguese | Colecistectomia |
Ontology: Postcholecystectomy Syndrome (C0152099)
Definition (MSH) | Abdominal symptoms after removal of the GALLBLADDER. The common postoperative symptoms are often the same as those present before the operation, such as COLIC, bloating, NAUSEA, and VOMITING. There is pain on palpation of the right upper quadrant and sometimes JAUNDICE. The term is often used, inaccurately, to describe such postoperative symptoms not due to gallbladder removal. |
Concepts | Disease or Syndrome (T047) |
MSH | D017562 |
ICD9 | 576.0 |
ICD10 | K91.5 |
SnomedCT | 90782003 |
English | Postcholecystectomy Syndrome, Post-Cholecystectomy Syndrome, Post Cholecystectomy Syndrome, Post-Cholecystectomy Syndromes, Postcholecystectomy Syndromes, Syndrome, Post-Cholecystectomy, Syndromes, Post-Cholecystectomy, Syndromes, Postcholecystectomy, Syndrome, Postcholecystectomy, Post cholecystectomy syndrome, postcholecystectomy syndrome (diagnosis), postcholecystectomy syndrome, Postcholecystectomy synd, Postcholecystectomy Syndrome [Disease/Finding], post-cholecystectomy syndrome, post cholecystectomy syndrome, Postcholecystectomy syndrome, Post-cholecystectomy syndrome, Postcholecystectomy syndrome (disorder), postcholecystectomy; syndrome, syndrome; postcholecystectomy |
Italian | Sindrome postcolecistectomia, Sindrome post-colecistectomia, Sindrome post colecistectomia |
Spanish | Síndrome postcolecistectomía, síndrome poscolecistectomía, síndrome postcolecistectomía (trastorno), síndrome postcolecistectomía, Síndrome de postcolecistectomía, Síndrome Poscolecistectomía |
Swedish | Postkolecystektomisyndrom |
Japanese | タンノウテキシュツジュツゴショウコウグン, 胆のう切除後症候群, 胆のう切除術後症候群, 胆嚢摘出後症候群, 胆嚢切除後症候群, 水ため症候群, 胆嚢切除術後症候群, 胆嚢摘出術後症候群, Sump症候群 |
Czech | postcholecystektomický syndrom, Postcholecystektomický syndrom |
Finnish | Sappirakonpoiston jälkeinen oireyhtymä |
Russian | POSTKHOLETSISTEKTOMICHESKII SINDROM, ПОСТХОЛЕЦИСТЭКТОМИЧЕСКИЙ СИНДРОМ |
Korean | 담낭절제술후 증후군 |
Polish | Zespół po cholecystektomii, Zespół po choledochostomii, Zespół SUMP |
Hungarian | Cholecystectomia utáni syndroma, Postcholecystectomiás syndroma |
Norwegian | Postkolecystektomisyndrom |
Dutch | post-cholecystectomie; syndroom, syndroom; post-cholecystectomie, postcholecystectomiesyndroom, Post-cholecystectomiesyndroom, Syndroom, post-cholecystectomie- |
Portuguese | Síndrome pós-colecistectomia, Síndrome Pós-Colecistectomia |
German | Post-Cholezystektomie-Syndrom, Postcholezystektomie-Syndrom |
French | Syndrome postcholécystectomie, Syndrome post-cholécystectomie |
Ontology: Cholecystectomy, Laparoscopic (C0162522)
Definition (NCI) | Surgical removal of the gallbladder,using a laparoscope. |
Definition (MSH) | Excision of the gallbladder through an abdominal incision using a laparoscope. |
Concepts | Therapeutic or Preventive Procedure (T061) |
MSH | D017081 |
ICD9 | 51.23 |
ICD10 | 30445-00 |
SnomedCT | 45595009 |
CPT | 47562 |
English | Cholecystectomy, Celioscopic, Laparoscopic Cholecystectomy, Cholecystectomy, Laparoscopic, Celioscopic Cholecystectomies, Celioscopic Cholecystectomy, Cholecystectomies, Celioscopic, Cholecystectomies, Laparoscopic, Laparoscopic Cholecystectomies, Laparoscopy, surgical; cholecystectomy, laparoscopic cholecystectomy (treatment), laparoscopic cholecystectomy, lap chole, Laparoscopic cholecystec, cholecystectomy endoscopic, cholecystectomy laparoscopic, LAPAROSCOPY SURG CHOLECYSTECTOMY, Surgical laparoscopy with cholecystectomy, Laparoscopic cholecystectomy, Endoscopic cholecystectomy, Laparoscopic cholecystectomy (procedure), LAPAROSCOPIC CHOLECYSTECTOMY |
Swedish | Gallblåseoperation med laparoskop |
Czech | cholecystektomie laparoskopická |
Finnish | Laparoskooppinen kolekystektomia |
Russian | KHOLETSISTEKTOMIIA LAPAROSKOPICHESKAIA, LAPAROSKOPICHESKAIA KHOLETSISTEKTOMIIA, ЛАПАРОСКОПИЧЕСКАЯ ХОЛЕЦИСТЭКТОМИЯ, ХОЛЕЦИСТЭКТОМИЯ ЛАПАРОСКОПИЧЕСКАЯ |
Italian | Colecistectomia in celioscopia, Colecistectomia in laparoscopia |
French | Cholécystectomie par laparoscopie, Cholécystectomie coelioscopique, Cholécystectomie sous coelioscopie, Cholécystectomie laparoscopique, Cholécystectomie par coelioscopie, Cholécystectomie sous laparoscopie |
Croatian | KOLECISTEKTOMIJA, LAPAROSKOPSKA |
Polish | Laparoskopowe wycięcie pęcherzyka żółciowego., Cholecystektomia laparoskopowa |
Japanese | 胆嚢切除-腹腔鏡, 腹腔鏡下胆嚢摘出術, 腹腔鏡胆嚢切除, 腹腔鏡胆嚢切除術, 胆嚢切除-腹腔鏡下, 胆嚢切除術-腹腔鏡, 胆嚢摘出-腹腔鏡下, 胆嚢摘出術-腹腔鏡下, 腹腔鏡下胆嚢切除, 腹腔鏡下胆嚢切除術, 腹腔鏡下胆嚢摘出 |
Norwegian | Laparoskopisk galleblærekirurgi, Laparoskopisk kolecystektomi, Kolecystektomi, laparoskopisk, Galleblærekirurgi, laparoskopisk, Laparoskopisk galleblæreoperasjon, Galleblæreoperasjon, laparoskopisk |
Spanish | colecistectomía laparoscópica (procedimiento), colecistectomía laparoscópica, Colecistectomía Celioscopica, Colecistectomía Laparoscópica |
German | Cholezystektomie, laparoskopische, Laparoskopische Cholezystektomie, Cholezystektomie, zölioskopische |
Dutch | Cholecystectomie, lapaoscopische, Cholecystectomie, laparoscopische, Laparoscopische cholecystectomie |
Portuguese | Colecistectomia Laparoscópica |