From the Guidelines
Laparoscopic cholecystectomy (LC) is indicated for symptomatic gallstone disease, including acute cholecystitis, and should be attempted as the first-line treatment, even in elderly patients, as it is safe and feasible with a low complication rate, as stated in the 2017 WSES and SICG guidelines 1. The indications for LC include:
- Symptomatic gallstone disease, such as biliary colic, acute cholecystitis, and biliary pancreatitis
- Gallstone-related complications, such as choledocholithiasis
- Gallbladder polyps larger than 1 cm
- Porcelain gallbladder due to its association with gallbladder cancer
- Acalculous cholecystitis LC may also be performed prophylactically in certain high-risk populations, such as patients with sickle cell disease or those awaiting organ transplantation. The procedure is generally preferred over open cholecystectomy due to its minimally invasive nature, resulting in less postoperative pain, shorter hospital stays, quicker recovery, and better cosmetic outcomes, as supported by the 2020 World Society of Emergency Surgery updated guidelines 1. However, contraindications should be considered, including inability to tolerate general anesthesia, uncorrected coagulopathy, end-stage liver disease with portal hypertension, or suspected gallbladder cancer where an open approach may be more appropriate. The timing of LC depends on the clinical scenario, with early intervention (within 24-72 hours) recommended for acute cholecystitis to reduce complications and hospital stay, as stated in the 2020 World Society of Emergency Surgery updated guidelines 1. In elderly patients, LC is safe and feasible, with a low complication rate, and should be attempted as the first-line treatment, as stated in the 2017 WSES and SICG guidelines 1. The evaluation of the risk for elderly patients with acute cholecystitis should include mortality rate, rate of gallstone-related disease relapse, age-related life expectancy, and patient frailty evaluation, as stated in the 2017 WSES and SICG guidelines 1.
From the Research
Indications for Laparoscopic Cholecystectomy
The indications for laparoscopic cholecystectomy (LC) include:
- Symptomatic cholelithiasis 2, 3
- Acute cholecystitis, with the procedure being safe and effective when performed early, preferably before 3 days after the onset of symptoms 4, 5, 6
- Chronic cholecystitis 4
Contraindications
Contraindications for LC include:
- Pregnancy 2
- Acute cholangitis 2
- Advanced cholecystitis 2
- Acute pancreatitis 2
- Peritonitis 2
- Significant bleeding disorder 2
- Portal hypertension 2
- Prior major upper abdominal operation 2
Benefits
The benefits of LC include:
- Shorter postoperative stay 4, 2, 3
- Lower morbidity 4, 3
- Less mortality than open surgery 4
- Reduced postoperative pain and recuperation time 3
- Technical feasibility and safety comparable to open cholecystectomy 5
Considerations
Considerations for LC in acute cholecystitis include: