Perioperative management - Cholecystectomy, laparoscopic - general and visceral surgery
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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
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
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
Special preparation
- In acute cholecystitis and choledocholithiasis: Perioperative antibiotic regimen
- Otherwise: Perioperative single-shot antibiotic prophylaxis
Informed consent
- Conversion to open cholecystectomy
- Biliary duct injury
- Gallbladder perforation
- Intraabdominal loss of gallstones
- Vascular injury (hepatic artery, portal vein)
- Injury to adjacent organs Duodenum, small intestine, colon, liver
- Peritonitis
- Abscess
- Redo procedure
Anesthesia
Positioning
Operating room setup
Special instruments and fixation systems
Postoperative management
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