Acute cholecystitis surgery

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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]


Surgery is the mainstay of treatment for acute cholecystitis (calculous and acalculous).Laparoscopic cholecystectomy is the gold standard for the treatment of acute cholecystitis and is usually preferred over the open cholecystectomy. Percutaneous cholecystostomy (PC) is an alternative to emergency cholecystectomy in complicated cases of high-risk patients.


Lapascopic cholecystectomy

There are two main types of procedures used for the laparoscopic cholecystectomy ; Single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC).[12][13][14][15]

  • 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 intraoperative blood loss


  • Indications of laparoscopic cholecystitis are:[16][17]
    • Cholecystitis (Acute/Chronic)
    • Symptomatic cholelithiasis
    • Biliary dyskinesia
    • Acalculous cholecystitis
    • Gallstone pancreatitis
    • Gallbladder masses/polyps


  • Contraindications of laparoscopic cholecystitis are:[16][17]
    • Inability to tolerate pneumoperitoneum or general anesthesia
    • Uncorrectable coagulopathy
    • Metastatic disease

Percutaneous cholecystostomy

Percutaneous cholecystostomy (PC) is an alternative to emergency cholecystectomy in complicated cases of high-risk patients.[1][18][19]


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  2. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW (1992). "Laparoscopic cholecystectomy. The new 'gold standard'?". Arch Surg. 127 (8): 917–21, discussion 921–3. PMID 1386505.
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  5. Bagla P, Sarria JC, Riall TS (2016). "Management of acute cholecystitis". Curr. Opin. Infect. Dis. 29 (5): 508–13. doi:10.1097/QCO.0000000000000297. PMID 27429137.
  6. Lo CM, Liu CL, Fan ST, Lai EC, Wong J (1998). "Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis". Ann. Surg. 227 (4): 461–7. PMC 1191296. PMID 9563529.
  7. Johansson M, Thune A, Blomqvist A, Nelvin L, Lundell L (2003). "Management of acute cholecystitis in the laparoscopic era: results of a prospective, randomized clinical trial". J. Gastrointest. Surg. 7 (5): 642–5. PMID 12850677.
  8. Lai PB, Kwong KH, Leung KL, Kwok SP, Chan AC, Chung SC, Lau WY (1998). "Randomized trial of early versus delayed laparoscopic cholecystectomy for acute cholecystitis". Br J Surg. 85 (6): 764–7. doi:10.1046/j.1365-2168.1998.00708.x. PMID 9667702.
  9. Kolla SB, Aggarwal S, Kumar A, Kumar R, Chumber S, Parshad R, Seenu V (2004). "Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective randomized trial". Surg Endosc. 18 (9): 1323–7. doi:10.1007/s00464-003-9230-6. PMID 15803229.
  10. 10.0 10.1 10.2 Ozkardeş AB, Tokaç M, Dumlu EG, Bozkurt B, Ciftçi AB, Yetişir F, Kılıç M (2014). "Early versus delayed laparoscopic cholecystectomy for acute cholecystitis: a prospective, randomized study". Int Surg. 99 (1): 56–61. doi:10.9738/INTSURG-D-13-00068.1. PMC 3897343. PMID 24444271.
  11. Cao AM, Eslick GD, Cox MR (2015). "Early Cholecystectomy Is Superior to Delayed Cholecystectomy for Acute Cholecystitis: a Meta-analysis". J. Gastrointest. Surg. 19 (5): 848–57. doi:10.1007/s11605-015-2747-x. PMID 25749854.
  12. 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.
  13. 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.
  14. 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.
  15. 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.
  16. 16.0 16.1 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.
  17. 17.0 17.1 Fletcher DR (2001). "Gallstones. Modern management". Aust Fam Physician. 30 (5): 441–5. PMID 11432016.
  18. 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.
  19. 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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