Cholecystectomy
Cholecystectomy
“Lap chole”
A cholecystectomy is usually
a laparoscopic procedure,
but in cases where a
laparoscopic cholecystectomy
cannot be completed safely,
an open cholecystectomy is
indicated.
(Open cholecystectomies are done in the event of
abdominal trauma, bleeding complications, or
unclear anatomy, although they are rare.)
Cholecystectomy
Cholecystectomy
Indications/Contraindications
Indications:
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Gallbladder issues
○ Biliary colic
○ acute/chronic/
acalculous
cholecystitis
○ Choledocolithiasis
Gallstone Pancreatitis
Contraindications:
Absolute:
● Inability to tolerate general
anesthesia
● Suspicious for: bladder
cancer
Relative
● Pregnancy (1st or 3rd)
● Abdominal sx (precluding
laparoscopic access)
● Cirrhosis, portal HTN,
bleeding disorders
Cholecystectomy
Potential risks –
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Bleeding
Infection
Bile leak
Intestinal injury
Surgical/systemic complications
○ PNA, VTE, CV events
● Post-op Choledocolithiasis
Cholecystectomy
Benefits–
● Less discomfort than an open surgery
● Shorter hospital stay with a quicker recovery time when
compared to an open surgery
● Smaller scars than regular surgery
Cholecystectomy
Technique
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4 small incisions are made in the abdomen: 1 periumbilical, 1
subxiphoid, 1 medial subcostal, and 1 lateral subcostal.
The laparoscope is introduced through the umbilical trocar.
A ratcheted toothed grasper is used to push the fundus of the
gallbladder superiorly and laterally to reveal the infundibulum and
porta hepatis.
Another grasper is attached to the infundibulum to retract the
gallbladder inferiorly and laterally to help visualize the cystic
artery and duct.
The cystic artery and duct are clipped and then transected.
Electrocautery or a scalpel is then used to separate the
gallbladder from the liver bed completely.
The gallbladder is removed through the umbilical incision.
Closure of port sites is surgeon specific, but fascial closure of sites
greater than 5 mm is recommended.
Cholecystectomy
Complications
● Intestinal or mesenteric injury
○ Via:
● Bile leak
● Bile duct injury
● Gallbladder perforation
○ Spilled stone retention (10%)
● Common bile duct stone retention
● Vascular injury
●
Postcholecystectomy
syndrome
Patient Education: Post-operative
● Analgesics: take as prescribed
○ Potential for pain: abdominal,
shoulder, or neck
● Diet: clear liquids → as tolerated
● Length of stay:
○ Laparoscopic: same day
○ Open: 1-2d. hospital stay
● Activity: ambulation
○
Avoid heavy lifting, sports, & swimming
x1 week
Cholecystectomy
Stool softener → narcotics
● Notify staff if any of the
following present:
○ Fever, chills
○ Erythema/edema at
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surgical site
N/V
Cramping, severe
abdominal pain
Jaundice: skin or eyes
Dark urine
Bloating