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Perioperative management - Cholecystectomy, laparoscopic

general and visceral surgery
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Indications

    • Symptomatic cholecystolithiasis
    • Acute cholecystitis (if at all possible during the first 48-72 hours, or 6 weeks after acute inflammation when the patient is asymptomatic.
    • Chronic cholecystitis (with/without gallstones)
    • Calculous obstruction of the cystic duct

  2. Contraindications

    • Tumors of the gallbladder and biliary tract
    • Major intraabdominal adhesions
    • Bilioenteric fistulas
    • Third trimester pregnancy
    • Mirizzi syndrome (rare type of obstructive jaundice)

    Relative contraindications

    • Acute pancreatitis
    • Portal hypertension

  3. Preoperative diagnostic work-up

    • Ultrasonography (gallstone confirmation, sizing of calculi, working up acute cholecystitis, CBD diameter to rule out cholestasis
    • Gastroscopy (for diagnostic work-up and differential diagnosis [gastritis/ulcer])
    • In lab parameters suggesting cholestasis: ERCP or alternatively MRCP (benefit: No risk of pancreatitis; drawback: No intervention possible)
    • CT (or MRI) in suspected malignancy

  4. Special preparation

    • In acute cholecystitis and choledocholithiasis: Perioperative antibiotic regimen
    • Otherwise: Perioperative single-shot antibiotic prophylaxis
Informed consent

Conversion to open cholecystectomyBiliary duct injuryGallbladder perforationIntraabdominal loss of

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