Chapter 57 - 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; traumatic perforation of the gallbladder; and biliary dyskinesia (low gallbladder ejection fraction). 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 and may be necessary for exposure of the porta hepatis in some patients undergoing portacaval shunt procedures.

Cholecystectomy can best be performed within 48 hours of admission for patients with acute cholecystitis documented on ultrasonography or radionuclide scanning (i.e., HIDA scan) unless general anesthesia is contraindicated. In patients with acute cholecystitis of longer duration, the extent of inflammation may make a laparoscopic approach difficult. If cholecystectomy is to be scheduled electively for acute cholecystitis, it is appropriate to give antibiotics until the time of surgery to help the inflammation subside. 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.