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==Overview==
==Overview==
Gallbladder removal, [[cholecystectomy]], can be accomplished by the open surgery or a [[laparoscopic]] procedure. Laparoscopic cholecystectomy is the operation of choice in uncomplicated calculous cholecystitis. Open cholecystectomy may be performed in complicated cases or when trained/skilled personal for laparoscopic procedure is not available. Supportive measures are instituted in the meantime to prepare the patient for surgery. These measures include fluid resuscitation and [[antibiotic]]s. Antibiotic regimens usually consist of a broad spectrum [[cephalosporin]] such as [[ceftriaxone]] and an antibacterial with good cover against [[anaerobic organism|anaerobic bacteria]], such as [[metronidazole]].


==Surgery==
==Surgery==
[[Image:Laprascopy-Roentgen.jpg|thumb|left|260px|X-Ray during laparoscopic cholecystectomy]]
For most patients, in most centres, the definitive treatment is surgical removal of the gallbladder. Supportive measures are instituted in the meantime and to prepare the patient for surgery. These measures include fluid resuscitation and [[antibiotic]]s. Antibiotic regimens usually consist of a broad spectrum [[cephalosporin]] such as [[ceftriaxone]] and an antibacterial with good cover against [[anaerobic organism|anaerobic bacteria]], such as [[metronidazole]]. 


Gallbladder removal, [[cholecystectomy]], can be accomplished via open surgery or a [[laparoscopic]] procedure. Laparoscopic procedures can have less [[morbidity]] and a shorter recovery stay.  Open procedures are usually done if complications have developed or the patient has had prior surgery to the area, making laparoscopic surgery technically difficult. A laparoscopic procedure may also be 'converted' to an open procedure during the operation if the surgeon feels that further attempts at laparoscopic removal might harm the patient. Open procedure may also be done if the surgeon does not know how to perform a laparoscopic cholesystectomy.
Removal of the gallbladder may be done by open surgery or a [[laparoscopic]] approach. Laparoscopic cholecystectomy is the procedure of choice in uncomplicated calculous cholecystitis. Open cholecystectomy may be performed in complicated cases or when trained or skilled personal for laparoscopic procedure is not available. Supportive measures such as fluid resuscitation and [[antibiotic]]s are instituted in the meantime to prepare the patient for surgery. Antibiotic regimens usually consist of a broad spectrum [[cephalosporin]] such as [[ceftriaxone]] and an antibacterial with good cover against [[anaerobic organism|anaerobic bacteria]], such as [[metronidazole]].<ref name="pmid9511287">{{cite journal |vauthors=Movchun AA, Koloss OE, Oppel' TA, Abdullaeva UA |title=[Surgical treatment of chronic calculous cholecystitis and its complications] |language=Russian |journal=Khirurgiia (Mosk) |volume= |issue=1 |pages=8–10 |year=1998 |pmid=9511287 |doi= |url=}}</ref><ref name="pmid11432016">{{cite journal |vauthors=Fletcher DR |title=Gallstones. Modern management |journal=Aust Fam Physician |volume=30 |issue=5 |pages=441–5 |year=2001 |pmid=11432016 |doi= |url=}}</ref>


In cases of severe inflammation, shock, or if the patient has higher risk for general anesthesia (required for [[cholecystectomy]]), the managing physician may elect to have an [[interventional radiology|interventional radiologist]] insert a [[percutaneous]] drainage catheter into the gallbladder ('percutaneous cholecystostomy tube') and treat the patient with antibiotics until the acute inflammation resolves.  The patient may later warrant [[cholecystectomy]] if their condition improves.
===Laparoscopic cholecystectomy===
Laparoscopic cholecystectomy is a minimally invasive surgical procedure and has various indications in addition to the chronic cholecystitis. There are two main types of procedures used for the laparoscopic [[cholecystectomy]] ; Single-incision laparoscopic [[cholecystectomy]] (SILC) and conventional multiport laparoscopic [[cholecystectomy]] (CMLC).<ref name="pmid23557447">{{cite journal |vauthors=Sato N, Yabuki K, Shibao K, Mori Y, Tamura T, Higure A, Yamaguchi K |title=Risk factors for a prolonged operative time in a single-incision laparoscopic cholecystectomy |journal=HPB (Oxford) |volume=16 |issue=2 |pages=177–82 |year=2014 |pmid=23557447 |pmc=3921014 |doi=10.1111/hpb.12100 |url=}}</ref><ref name="pmid20607556">{{cite journal |vauthors=Antoniou SA, Pointner R, Granderath FA |title=Single-incision laparoscopic cholecystectomy: a systematic review |journal=Surg Endosc |volume=25 |issue=2 |pages=367–77 |year=2011 |pmid=20607556 |doi=10.1007/s00464-010-1217-5 |url=}}</ref><ref name="pmid22819642">{{cite journal |vauthors=Leung D, Yetasook AK, Carbray J, Butt Z, Hoeger Y, Denham W, Barrera E, Ujiki MB |title=Single-incision surgery has higher cost with equivalent pain and quality-of-life scores compared with multiple-incision laparoscopic cholecystectomy: a prospective randomized blinded comparison |journal=J. Am. Coll. Surg. |volume=215 |issue=5 |pages=702–8 |year=2012 |pmid=22819642 |doi=10.1016/j.jamcollsurg.2012.05.038 |url=}}</ref><ref name="pmid22767084">{{cite journal |vauthors=Pisanu A, Reccia I, Porceddu G, Uccheddu A |title=Meta-analysis of prospective randomized studies comparing single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC) |journal=J. Gastrointest. Surg. |volume=16 |issue=9 |pages=1790–801 |year=2012 |pmid=22767084 |doi=10.1007/s11605-012-1956-9 |url=}}</ref>
*Single-incision [[laparoscopic cholecystectomy]] (SILC)
**As compared to CMLC, SILC has the following features:
***Improved cosmetic results
***Decreased postoperative pain
***Increased operative time
***Increased intraoperative blood loss
*Conventional multiport laparoscopic [[cholecystectomy]] (CMLC)
**As compared to SILC, CMLC has the following features:
***Decreased operative time
***Decreased intra-operative blood loss


====Indications====
*Indications of laparoscopic cholecystitis are:<ref name="pmid9511287">{{cite journal |vauthors=Movchun AA, Koloss OE, Oppel' TA, Abdullaeva UA |title=[Surgical treatment of chronic calculous cholecystitis and its complications] |language=Russian |journal=Khirurgiia (Mosk) |volume= |issue=1 |pages=8–10 |year=1998 |pmid=9511287 |doi= |url=}}</ref><ref name="pmid11432016">{{cite journal |vauthors=Fletcher DR |title=Gallstones. Modern management |journal=Aust Fam Physician |volume=30 |issue=5 |pages=441–5 |year=2001 |pmid=11432016 |doi= |url=}}</ref>
**Cholecystitis (acute/chronic)
**Symptomatic [[cholelithiasis]]
**Biliary [[dyskinesia]]
**Acalculous cholecystitis
**Gallstone [[pancreatitis]]
**Gallbladder mass or polyps
====Contraindications====
The contraindications of laparoscopic cholecystitis include:<ref name="pmid9511287">{{cite journal |vauthors=Movchun AA, Koloss OE, Oppel' TA, Abdullaeva UA |title=[Surgical treatment of chronic calculous cholecystitis and its complications] |language=Russian |journal=Khirurgiia (Mosk) |volume= |issue=1 |pages=8–10 |year=1998 |pmid=9511287 |doi= |url=}}</ref><ref name="pmid11432016">{{cite journal |vauthors=Fletcher DR |title=Gallstones. Modern management |journal=Aust Fam Physician |volume=30 |issue=5 |pages=441–5 |year=2001 |pmid=11432016 |doi= |url=}}</ref>
*Inability to tolerate [[pneumoperitoneum]] or general [[anesthesia]]
*Uncorrectable [[coagulopathy]]
*Metastatic disease
====Major Complications of cholecystectomy====
The major complications associated with the cholecystectomy are:<ref name="urlwww.ncbi.nlm.nih.gov">{{cite web |url=http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1358029/pdf/annsurg00170-0061.pdf |title=www.ncbi.nlm.nih.gov |format= |work= |accessdate=2012-08-20}}</ref>
*[[Abscess]]
*[[Ascending cholangitis]]
*Bile duct injury
*[[Bleeding]] (liver surface and cystic artery most common sites)
*[[Hernia]]
*[[Pancreatitis]]
*[[Perforation]] or [[rupture]]
*[[Wound]] [[infection]]
*Organ injury (intestine and liver at highest risk, especially if [[gallbladder]] through inflammation has become scarred or adherent to other organs (e.g. [[transverse colon]]))
*[[Deep vein thrombosis]]/[[pulmonary embolism]] (unusual- risk can be decreased through use of sequential compression devices on legs during surgery)


===Percutaneous cholecystostomy===
Percutaneous cholecystostomy (PC) is an alternative to emergency [[cholecystectomy]] in complicated cases of high-risk patients.<ref name="pmid24679431">{{cite journal |vauthors=Knab LM, Boller AM, Mahvi DM |title=Cholecystitis |journal=Surg. Clin. North Am. |volume=94 |issue=2 |pages=455–70 |year=2014 |pmid=24679431 |doi=10.1016/j.suc.2014.01.005 |url=}}</ref><ref name="pmid28603584">{{cite journal |vauthors=Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF |title=Acute calculous cholecystitis: Review of current best practices |journal=World J Gastrointest Surg |volume=9 |issue=5 |pages=118–126 |year=2017 |pmid=28603584 |pmc=5442405 |doi=10.4240/wjgs.v9.i5.118 |url=}}</ref><ref name="pmid26580708">{{cite journal |vauthors=Yeo CS, Tay VW, Low JK, Woon WW, Punamiya SJ, Shelat VG |title=Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy |journal=J Hepatobiliary Pancreat Sci |volume=23 |issue=1 |pages=65–73 |year=2016 |pmid=26580708 |doi=10.1002/jhbp.304 |url=}}</ref>
*The results showed that the mortality, morbidity and conversion rate were the same in PC and [[laparoscopic cholecystectomy]].
*Older patients with increased comorbidities usually undergo [[cholecystectomy]].
*If a patient is not a good surgical candidate at the time of presentation, [[cholecystectomy]] is preferred. Patients usually have [[biliary]] complications and [[cholecystectomy]] is required ultimately.


[[Image:Laprascopy-Roentgen.jpg|thumb|center|260px|X-Ray during laparoscopic cholecystectomy]]


==References==
{{reflist|2}}


==References==
[[Category:Gastroenterology]]
{{Reflist|2}}
[[Category:Hepatology]]
[[Category:Surgery]]
[[Category:Emergency medicine]]
 
 
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Latest revision as of 21:15, 21 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Furqan M M. M.B.B.S[2]

Overview

Gallbladder removal, cholecystectomy, can be accomplished by the open surgery or a laparoscopic procedure. Laparoscopic cholecystectomy is the operation of choice in uncomplicated calculous cholecystitis. Open cholecystectomy may be performed in complicated cases or when trained/skilled personal for laparoscopic procedure is not available. Supportive measures are instituted in the meantime to prepare the patient for surgery. These measures include fluid resuscitation and antibiotics. Antibiotic regimens usually consist of a broad spectrum cephalosporin such as ceftriaxone and an antibacterial with good cover against anaerobic bacteria, such as metronidazole.

Surgery

Removal of the gallbladder may be done by open surgery or a laparoscopic approach. Laparoscopic cholecystectomy is the procedure of choice in uncomplicated calculous cholecystitis. Open cholecystectomy may be performed in complicated cases or when trained or skilled personal for laparoscopic procedure is not available. Supportive measures such as fluid resuscitation and antibiotics are instituted in the meantime to prepare the patient for surgery. Antibiotic regimens usually consist of a broad spectrum cephalosporin such as ceftriaxone and an antibacterial with good cover against anaerobic bacteria, such as metronidazole.[1][2]

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a minimally invasive surgical procedure and has various indications in addition to the chronic cholecystitis. There are two main types of procedures used for the laparoscopic cholecystectomy ; Single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC).[3][4][5][6]

  • Single-incision laparoscopic cholecystectomy (SILC)
    • As compared to CMLC, SILC has the following features:
      • Improved cosmetic results
      • Decreased postoperative pain
      • Increased operative time
      • Increased intraoperative blood loss
  • Conventional multiport laparoscopic cholecystectomy (CMLC)
    • As compared to SILC, CMLC has the following features:
      • Decreased operative time
      • Decreased intra-operative blood loss

Indications

Contraindications

The contraindications of laparoscopic cholecystitis include:[1][2]

Major Complications of cholecystectomy

The major complications associated with the cholecystectomy are:[7]

Percutaneous cholecystostomy

Percutaneous cholecystostomy (PC) is an alternative to emergency cholecystectomy in complicated cases of high-risk patients.[8][9][10]

X-Ray during laparoscopic cholecystectomy

References

  1. ↑ 1.0 1.1 1.2 Movchun AA, Koloss OE, Oppel' TA, Abdullaeva UA (1998). "[Surgical treatment of chronic calculous cholecystitis and its complications]". Khirurgiia (Mosk) (in Russian) (1): 8–10. PMID 9511287.
  2. ↑ 2.0 2.1 2.2 Fletcher DR (2001). "Gallstones. Modern management". Aust Fam Physician. 30 (5): 441–5. PMID 11432016.
  3. ↑ Sato N, Yabuki K, Shibao K, Mori Y, Tamura T, Higure A, Yamaguchi K (2014). "Risk factors for a prolonged operative time in a single-incision laparoscopic cholecystectomy". HPB (Oxford). 16 (2): 177–82. doi:10.1111/hpb.12100. PMC 3921014. PMID 23557447.
  4. ↑ Antoniou SA, Pointner R, Granderath FA (2011). "Single-incision laparoscopic cholecystectomy: a systematic review". Surg Endosc. 25 (2): 367–77. doi:10.1007/s00464-010-1217-5. PMID 20607556.
  5. ↑ Leung D, Yetasook AK, Carbray J, Butt Z, Hoeger Y, Denham W, Barrera E, Ujiki MB (2012). "Single-incision surgery has higher cost with equivalent pain and quality-of-life scores compared with multiple-incision laparoscopic cholecystectomy: a prospective randomized blinded comparison". J. Am. Coll. Surg. 215 (5): 702–8. doi:10.1016/j.jamcollsurg.2012.05.038. PMID 22819642.
  6. ↑ Pisanu A, Reccia I, Porceddu G, Uccheddu A (2012). "Meta-analysis of prospective randomized studies comparing single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC)". J. Gastrointest. Surg. 16 (9): 1790–801. doi:10.1007/s11605-012-1956-9. PMID 22767084.
  7. ↑ "www.ncbi.nlm.nih.gov" (PDF). Retrieved 2012-08-20.
  8. ↑ Knab LM, Boller AM, Mahvi DM (2014). "Cholecystitis". Surg. Clin. North Am. 94 (2): 455–70. doi:10.1016/j.suc.2014.01.005. PMID 24679431.
  9. ↑ Gomes CA, Junior CS, Di Saverio S, Sartelli M, Kelly MD, Gomes CC, Gomes FC, Corrêa LD, Alves CB, Guimarães SF (2017). "Acute calculous cholecystitis: Review of current best practices". World J Gastrointest Surg. 9 (5): 118–126. doi:10.4240/wjgs.v9.i5.118. PMC 5442405. PMID 28603584.
  10. ↑ Yeo CS, Tay VW, Low JK, Woon WW, Punamiya SJ, Shelat VG (2016). "Outcomes of percutaneous cholecystostomy and predictors of eventual cholecystectomy". J Hepatobiliary Pancreat Sci. 23 (1): 65–73. doi:10.1002/jhbp.304. PMID 26580708.


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