Cholecystectomy

Aka: Cholecystectomy, Laparoscopic Cholecystectomy

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II. Epidemiology

  1. Laparoscopic Cholecystectomy is the most common abdominal surgery in Europe and U.S. (900,000 cases per year)

III. Indications

  1. Biliary Colic
  2. Biliary Dyskinesia
  3. Calcified Gallbladder
  4. Acute Cholecystitis
    1. Urgently perform within 72 hours of onset
  5. Choledocholithiasis
    1. Perform after Common Bile Duct Stone is cleared with ERCP
  6. Gallstone Pancreatitis
    1. Perform after Pancreatitis resolves, before hospital discharge

IV. Contraindications: Laparoscopic Cholecystectomy

  1. Gallbladder cancer (absolute contraindication)
  2. Uncontrolled Coagulopathy (absolute contraindication)
  3. Advanced Cirrhosis or liver failure
  4. Coagulopathy
  5. Peritonitis
  6. Sepsis

V. Advantages: Laparoscopic Cholecystectomy (preferred)

  1. Decreased pain and Disability
    1. Much earlier return to work time
    2. Shorter hospital stay (often outpatient)
  2. Lower mortality
    1. Laparoscopic: 8 to 16 per 10,000 patients
    2. Open: 66 to 74 per 10,000 patients
    3. Shea (1996) Ann Surg 224:609-20 [PubMed]
  3. Treatment cost slightly less than open Cholecystectomy
  4. Better cosmetic result

VI. Management: Timing of Surgery - Early surgery is safe and preferred

  1. Incidence of technical complications is the same
  2. Reduces total illness duration by 30 days
  3. Hospitalization time reduced by 5-7 days
  4. Direct medical cost savings reduced by > $2000
  5. Death rate slightly lower with early surgery
  6. References
    1. Stevens (2006) Am J Surg 192:756-61 [PubMed]

VII. Management: Antibiotic prophylaxis

  1. Indications: Patients at high risk of Wound Infection
    1. Age over 60 years old
    2. Diabetes Mellitus
    3. Acute Biliary Colic within 30 days of surgery
    4. Jaundice
    5. Acute Cholecystitis
    6. Ascending Cholangitis
  2. Protocol
    1. Cefazolin 1 g IV within one hour of skin incision for one dose
    2. Continue other antibiotics as indicated (e.g. Ascending Cholangitis)
  3. References
    1. Choudhary (2008) J Gastrointest Surg 12(11): 1847-53 [PubMed]

VIII. Complications: Conversion from laparoscopy to open laparotomy

  1. Rates
    1. Uninflamed gallbladder: 2-15%
    2. Acute Cholecystitis: 6-35%
  2. Risk factors
    1. Male gender
    2. Over age 60 years
    3. History of upper abdominal surgery
    4. Ultrasound with thickened gallbladder wall
    5. Acute Cholecystitis
  3. References
    1. Tayeb (2005) J Postgrad Med 51(1): 17-20 [PubMed]

IX. Complications: Common Bile duct injury (Bile leak)

  1. Typically presents within 3 days of Laparoscopic Cholecystectomy
    1. Laparoscopic: 36 to 47 per 10,000 patients
    2. Open: 19 to 29 per 10,000 patients
    3. Shea (1996) Ann Surg 224:609-20 [PubMed]
  2. Diagnosis
    1. Ultrasound will show a free fluid collection around the biliary duct
    2. ERCP: Dye extravasates
    3. Ultrasound guided needle aspiration will reveal brown bile (as opposed to post-operative Hematoma)
  3. References
    1. Weinstock in Majoewsky (2012) EM:RAP 12(3): 3

X. Complications: Other

  1. Dropped Gallstone
    1. Gallstone drops during resection into the peritoneum
    2. Results in infection, forming an abscess or phlegmon

XI. References

  1. Abraham (2014) Am Fam Physician 89(10): 795-802 [PubMed]

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Related Studies

Ontology: Cholecystectomy procedure (C0008320)

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, ﾀﾝﾉｳｾﾂｼﾞｮ
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
Derived from the NIH UMLS (Unified Medical Language System)

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
Derived from the NIH UMLS (Unified Medical Language System)

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