From the Guidelines
Laparoscopic cholecystectomy should always be attempted first for an intraperitoneal approach, except in cases of absolute anesthetic contraindications and septic shock, as it is safe, feasible, and associated with a low complication rate and shortened hospital stay in elderly patients with acute cholecystitis. The criteria for an intraperitoneal approach for cholecystectomy include:
- The patient's clinical status and disease factors, such as the presence of acute cholecystitis, gallstone-related disease relapse, and age-related life expectancy 1
- The surgeon's experience and the availability of resources, such as the ability to perform laparoscopic cholecystectomy and the presence of a skilled surgical team 1
- The patient's risk factors, such as mortality rate, rate of gallstone-related disease relapse, and time to relapse, as well as the patient's frailty evaluation using frailty scores 1
- The optimal timing for laparoscopic cholecystectomy, which is within 48 hours and no more than 10 days from symptom appearance 1 The use of the critical view of safety (CVS) during laparoscopic cholecystectomy is recommended to minimize the risk of bile duct injuries, and conversion to open surgery may be considered in cases of difficult laparoscopic cholecystectomy or suspected bile duct injury 1. In patients with at-risk conditions, such as scleroatrophic cholecystitis or Mirizzi syndrome, an exhaustive preoperative work-up is mandatory to discuss and balance the risks/benefits ratio of the procedure 1. Overall, the decision to perform an intraperitoneal approach for cholecystectomy should be based on a careful evaluation of the patient's individual risk factors and the surgeon's experience and resources.
From the Research
Criteria for Intraperitoneal Approach for Cholecystectomy
The provided studies do not directly address the criteria for an intraperitoneal approach for cholecystectomy. However, they discuss the use of antibiotic prophylaxis in laparoscopic cholecystectomy, which may be relevant to the overall surgical approach.
Antibiotic Prophylaxis in Laparoscopic Cholecystectomy
- The use of antibiotic prophylaxis in laparoscopic cholecystectomy is controversial, with some studies suggesting that it may not be necessary in low-risk patients 2, 3, 4.
- A study published in 2015 found that a single dose of preoperative prophylactic cefazolin had no significant benefit in reducing the incidence of surgical site infections in laparoscopic cholecystectomy 2.
- Another study published in 2020 found that a single prophylactic dose of ceftriaxone was effective in preventing surgical site infections in patients undergoing laparoscopic cholecystectomy, but the study did not address the criteria for an intraperitoneal approach 5.
- The Surgical Infection Society guidelines recommend against routine use of peri-operative antibiotic agents in low-risk patients undergoing elective laparoscopic cholecystectomy, but recommend their use in patients undergoing laparoscopic cholecystectomy for acute cholecystitis 6.
Conclusion Not Applicable
As the provided studies do not directly address the criteria for an intraperitoneal approach for cholecystectomy, no conclusion can be drawn. The studies primarily focus on the use of antibiotic prophylaxis in laparoscopic cholecystectomy.