Chronic cholecystitis surgery: Difference between revisions

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Revision as of 16:14, 8 January 2018

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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

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.^[1]^[2]

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is a minimally invasive surgical procedure and has various indications in addition to the chronic cholecystitis.

Indications

Indications of laparoscopic cholecystitis:
- Cholecystitis (Acute/Chronic)
- Symptomatic cholelithiasis
- Biliary dyskinesia
- Acalculous cholecystitis
- Gallstone pancreatitis
- Gallbladder masses/polyps

Contraindications

Contraindications of laparoscopic cholecystitis are:
- Inability to tolerate pneumoperitoneum or general anesthesia
- Uncorrectable coagulopathy
- Metastatic disease

X-Ray during laparoscopic cholecystectomy

References

↑ 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.
↑ Fletcher DR (2001). "Gallstones. Modern management". Aust Fam Physician. 30 (5): 441–5. PMID 11432016.

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[pmid9511287-1] 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.

[pmid11432016-2] Fletcher DR (2001). "Gallstones. Modern management". Aust Fam Physician. 30 (5): 441–5. PMID 11432016.

[1]

[2]

@@ Line 2: / Line 2: @@
 {{Cholecystitis}}
 {{CMG}}
+==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==
-[[Image:Laprascopy-Roentgen.jpg|thumb|left|260px|X-Ray during laparoscopic cholecystectomy]]
+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]].<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>
-For most patients, in most centers, the definitive treatment is surgical removal of the gallbladder. 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]].
+===Laparoscopic cholecystectomy===
+Laparoscopic cholecystectomy is a minimally invasive surgical procedure and has various indications in addition to the chronic cholecystitis.
+====Indications====
+*Indications of laparoscopic cholecystitis:
+**Cholecystitis (Acute/Chronic)
+**Symptomatic cholelithiasis
+**Biliary dyskinesia
+**Acalculous cholecystitis
+**Gallstone pancreatitis
+**Gallbladder masses/polyps
+====Contraindications====
+*Contraindications of laparoscopic cholecystitis are:
+**Inability to tolerate pneumoperitoneum or general anesthesia
+**Uncorrectable coagulopathy
+**Metastatic disease
-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.
-In cases of severe [[inflammation]], [[shock]], or if the patient has a 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 the condition doesn't improve.
+[[Image:Laprascopy-Roentgen.jpg|thumb|left|260px|X-Ray during laparoscopic cholecystectomy]]
 ==References==