Background Information: Cholecystectomy is the surgical removal of the gallbladder. This procedure may be performed via the open procedure or minimally invasive (laparoscopic or robotic).
Indications:
- Acute Cholecystitis
- Symptomatic cholelithiasis (biliary colic)
- Choledocholithiasis
- Gallbladder pancreatitis
- Gallstone ileus
- Mirizzi Syndrome
- Gallbladder cancer
- Gallbladder polyps >1cm
- Porcelain gallbladder
Key Anatomy:
- Gallbladder
- Fundus
- Body
- Neck
- Infundibulum
- Triangle of Calot (hepatocystic triangle)
- Calot's (cystic) lymph node
- Cystic artery
- Cystic duct
- Common bile duct
- Common hepatic duct
- Rouviere's sulcus
Surgical Risks:
General surgical risks:
- Bleeding
- Infection
Risks specific to Cholecystectomy:
- Common bile duct injury (0.22% incidence for laparoscopic repairⁱ)
- Bile leak from the transected cystic duct (0.5% incidence for laparoscopic repairⁱ)
- Enterotomy
- 0.22% incidence for laparoscopic surgery²
- Postoperative ileus
- Risk lower for minimally invasive procedures vs. open
Additional Resources:
American College of Surgeons/Association for Surgical Education Core Curriculum
Osmosis:
- https://www.osmosis.org/learn/Acute_cholecystitis
- https://www.osmosis.org/learn/Chronic_cholecystitis
Online MedEd:
Text:
- Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice by Courtney M. Townsend Jr. JR. MD
- Zollinger's Atlas of Surgical Operations, Tenth Edition 10th Edition by Robert Zollinger, E. Ellison
- Atlas of General Surgical Techniques: Townsend, Evers
- Essentials of General Surgery 5th Edition, by Peter F. Lawrence MD, Richard M. Bell MD, Merril T. Dayton MD, James C. Hebert MD FACS
Other:
- The SAGES safe cholecystectomy program: https://www.sages.org/safe-cholecystectomy-program/
References:
- Fong ZV, Pitt HA, Strasberg SM, et al. Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes. J Am Coll Surg. 2018;226(4):568-576.e1. doi:10.1016/j.jamcollsurg.2017.12.023
- van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy. Br J Surg. 2004;91(10):1253-1258. doi:10.1002/bjs.4716
