What are the indications for a cholecystectomy (surgical removal of the gallbladder)?

From the Guidelines

Cholecystectomy is indicated for symptomatic gallstone disease, including biliary colic, acute cholecystitis, gallstone pancreatitis, and choledocholithiasis, and should be performed laparoscopically, preferably within 24-72 hours for acute cholecystitis, as it offers faster recovery, less pain, and shorter hospital stays compared to open surgery, as supported by the 2020 World Society of Emergency Surgery guidelines 1.

Indications for Cholecystectomy

• Symptomatic gallstone disease, including biliary colic, acute cholecystitis, gallstone pancreatitis, and choledocholithiasis
• Gallbladder polyps larger than 1 cm
• Porcelain gallbladder due to increased cancer risk
• Acalculous cholecystitis
• Asymptomatic gallstones in high-risk populations, such as patients with sickle cell disease, those awaiting organ transplantation, or individuals with gallbladder adenomas

Timing of Cholecystectomy

• Early cholecystectomy (within 24-72 hours) is preferred for acute cholecystitis to reduce complications and hospital stay, as recommended by the 2017 WSES guidelines for the management of intra-abdominal infections 1
• Delayed cholecystectomy may be considered for patients with complicated cholecystitis or those who are not suitable for early surgery

Surgical Approach

• Laparoscopic cholecystectomy is the preferred approach, as it offers faster recovery, less pain, and shorter hospital stays compared to open surgery, as supported by the 2020 World Society of Emergency Surgery guidelines 1
• Open cholecystectomy may be considered for patients with contraindications to laparoscopic surgery or those who require conversion to open surgery due to complications

Potential Complications

• Bile duct injury
• Bleeding
• Infection
• Conversion to open surgery
• Patients should be informed about these potential complications and the benefits of laparoscopic cholecystectomy, as recommended by the American College of Physicians guidelines 1

From the Research

Indications for Cholecystectomy

The indications for cholecystectomy include:

• Symptomatic gallstone disease, as current guidelines do not recommend cholecystectomy unless symptoms are present 2
• Acute cholecystitis, with laparoscopic cholecystectomy being the first-line therapy in most patient populations 3
• Gallstone pancreatitis, with laparoscopic cholecystectomy being the standard treatment 2
• Common bile duct stones, with same-admission cholecystectomy reducing the risk of recurrent complications 4
• Biliary pancreatitis, with same-admission cholecystectomy reducing the risk of recurrent complications 4

Patient-Specific Indications

Certain patient populations have specific indications for cholecystectomy:

• Pregnant women, with early laparoscopic cholecystectomy recommended during all trimesters to reduce maternal-fetal complications 3
• Patients older than 65 years of age, with laparoscopic cholecystectomy associated with lower mortality at 2-year follow-up 3
• Patients with liver cirrhosis, with cholecystectomy being considered for symptomatic cholelithiasis, taking into account anesthesiologic risks and perioperative complications 5

Timing of Cholecystectomy

The timing of cholecystectomy is also an important consideration:

• Early laparoscopic cholecystectomy (within 1-3 days of diagnosis) is associated with improved patient outcomes, including fewer composite postoperative complications and a shorter length of hospital stay 3
• Same-admission cholecystectomy reduces the risk of recurrent complications in patients with mild-to-moderate complicated symptomatic gallstone disease 4