52 - Cholecystectomy

Summary

Cholecystectomy is indicated for symptomatic calculous cholecystitis (acute or chronic); acalculous acute cholecystitis; a gallbladder that releases stones into the common bile duct (obstructive jaundice, gallstone pancreatitis, cholangitis); carcinoma of the gallbladder; and traumatic perforation of the gallbladder. It is also performed after right hepatic artery ligation for hepatic trauma and in preparation for infusion of the hepatic artery with chemotherapeutic agents for metastases. It is included as part of a pancreatoduodenectomy by some surgeons and may be necessary for exposure of the porta hepatis in occasional patients undergoing portacaval shunt procedures.

Cholecystectomy is routinely performed within 24 hours of admission for patients with acute cholecystitis documented on ultrasonography or radionuclide scanning (i.e., HIDA scan) unless general anesthesia is contraindicated. If patients with acute cholecystitis are observed for a longer period, the extent of inflammation may make a laparoscopic approach difficult. Patients with obstructive jaundice, gallstone pancreatitis, or cholangitis undergo cholecystectomy after observation to determine whether the bilirubin level will fall, when the amylase level returns to normal, and when hemodynamic stability has been restored, respectively.

General anesthesia is used for both open and laparoscopic cholecystectomy. Open procedures are completed in 1 to 1½ hours, blood transfusions are essentially never necessary, and the stress of the routine procedure is moderate. If gangrenous cholecystitis with perforation is present, the underlying disease causes severe stress during the perioperative period. Most patients are discharged from the hospital 2 to 4 days after operation and return to work in 4 to 6 weeks.