II. Epidemiology
- Laparoscopic Cholecystectomy is the most common abdominal surgery in Europe and U.S. (900,000 cases per year)
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: 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
IX. 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
- 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 Majoewsky (2012) EM:RAP 12(3): 3
X. Complications: Other
XI. 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: 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 |