Perioperative management - Cholecystectomy, laparoscopic - general and visceral surgery

• 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

• 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

• 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

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

• 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