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Cholecystectomy

Indications
1. Biliary Colic
2. Biliary Dyskinesia
3. Calcified Gallbladder
4. Acute Cholecystitis (urgent, perform within 72 hours)
5. Choledocholithiasis (perform after common duct cleared)
6. Gallstone Pancreatitis (after Pancreatitis resolves)
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
Treatment protocol: Laparoscopy preferred method
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
3. Treatment cost slightly less than open Cholecystectomy
4. Better cosmetic result
Complications
1. Common Bile duct injury
  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

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This page was written by Scott Moses, MD, and was last revised 1/27/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 5.0.