From the Guidelines
Cholecystectomy is indicated for patients with symptomatic gallstones, acute cholecystitis, gallstone pancreatitis, or biliary dyskinesia with a gallbladder ejection fraction below 35%, as well as for those with gallbladder polyps larger than 1 cm, porcelain gallbladder, or gallbladder cancer. The procedure is typically performed laparoscopically, requiring 3-4 small incisions and allowing for same-day discharge in uncomplicated cases 1.
Indications for Cholecystectomy
- Symptomatic gallstones
- Acute cholecystitis
- Gallstone pancreatitis
- Biliary dyskinesia with a gallbladder ejection fraction below 35%
- Gallbladder polyps larger than 1 cm
- Porcelain gallbladder
- Gallbladder cancer
Surgical Approach
- Laparoscopic cholecystectomy is the preferred approach, except in cases of absolute anesthesiology contraindications or septic shock 1
- Open cholecystectomy may be necessary in cases with significant inflammation, adhesions, or anatomical variations
Timing of Surgery
- Early laparoscopic cholecystectomy should be performed as soon as possible, but can be performed up to 10 days of onset of symptoms 1
- Delayed cholecystectomy after 45 days is better than immediate surgery unless symptoms suggestive of worsening peritonitis or sepsis warrant an emergency surgical intervention 1
Special Considerations
- Asymptomatic gallstones generally don't require surgery unless the patient has specific risk factors like diabetes or is immunocompromised
- Patients should expect post-operative pain requiring analgesics for several days and should follow a low-fat diet initially to minimize digestive discomfort as the body adjusts to functioning without a gallbladder
- Old age (> 65 years) does not represent a contraindication to cholecystectomy for acute cholecystitis 1
From the Research
Indications for Cholecystectomy
The indications for cholecystectomy, or gallbladder removal surgery, include:
- Symptomatic gallstones, as they can cause biliary pain, gallstone-induced pancreatitis, or common duct stones 2
- Acute cholecystitis, which is a complication of gallstones and is generally recommended to be treated with early cholecystectomy to prevent longer hospital stays and convalescence due to recurrent episodes 3
- Gallstone pancreatitis, where cholecystectomy is recommended for patients to prevent recurrent episodes 4
- Biliary complications, such as common bile duct stones or biliary pancreatitis, where same-admission cholecystectomy may be beneficial 5
Patient Selection
It's essential to critically evaluate the indications for cholecystectomy in patients with uncomplicated symptomatic gallstone disease to prevent unnecessary surgeries, as up to 33% of patients may experience persistent abdominal pain after the procedure 5.
- Patients with asymptomatic gallstones or those with flatulence and dyspepsia who have gallstones should be observed rather than undergoing immediate surgery 2
- Those who refuse surgery or are not surgical candidates might be treated with dissolution therapy or other alternative methods 2
Timing of Cholecystectomy
The timing of cholecystectomy is also crucial:
- Early cholecystectomy is recommended for patients with acute cholecystitis to prevent longer hospital stays and convalescence due to recurrent episodes 3
- Same-admission cholecystectomy may be beneficial for patients with mild-to-moderate complicated symptomatic gallstone disease to reduce the risk of recurrent complications 5