What are the risks for cholecystectomy?

From the Guidelines

Cholecystectomy carries a minimal surgical risk, with a morbidity rate of 2%–8% and a mortality rate of two to seven per 1000 patients, as reported in the most recent study 1. The risks associated with cholecystectomy include bleeding, infection, and injury to surrounding structures such as the bile ducts, liver, or intestines. Patients may experience post-operative pain, which typically resolves within a few days to weeks. There's a small risk of bile leakage into the abdomen, which may require additional procedures to correct. Some patients develop diarrhea or digestive changes after gallbladder removal, as bile now flows directly from the liver into the small intestine rather than being stored and concentrated in the gallbladder. Key factors that influence the risk of cholecystectomy include:

• The surgical indication, with emergency procedures carrying a higher risk than elective surgeries
• Underlying comorbidities, such as cirrhosis, which can increase the risk of complications
• The patient's overall health status, with older adults and those with multiple comorbidities facing a higher risk of morbidity and mortality
• The surgical approach, with laparoscopic cholecystectomy generally considered safer than open surgery, as supported by a meta-analysis comparing early versus delayed laparoscopic cholecystectomy for acute cholecystitis 1. It is essential to weigh these risks against the benefits of the procedure and to carefully select patients for surgery, taking into account their individual risk profiles and health status, as emphasized by the SRU consensus conference committee 1.

From the FDA Drug Label

The prophylactic administration of Cefazolin for Injection, USP preoperatively, intraoperatively, and postoperatively may reduce the incidence of certain postoperative infections in patients undergoing surgical procedures which are classified as contaminated or potentially contaminated (e.g., vaginal hysterectomy and cholecystectomy in high-risk patients such as those older than 70 years, with acute cholecystitis, obstructive jaundice, or common duct bile stones).

The risks for cholecystectomy are not explicitly stated in the drug label, but it is mentioned that the procedure is classified as contaminated or potentially contaminated, especially in high-risk patients.

• The label does mention that perioperative prophylaxis with cefazolin may reduce the incidence of certain postoperative infections in patients undergoing cholecystectomy, particularly those who are at high risk 2. However, the specific risks associated with cholecystectomy are not directly addressed.

From the Research

Risks Associated with Cholecystectomy

The risks associated with cholecystectomy can be significant, and it's essential to understand these risks to make informed decisions. Some of the risks include:

• Morbidity and mortality: A study published in 1996 found that the morbidity and mortality rates for cholecystectomy in high-risk patients were 27% and 0.4%, respectively, compared to 14% and 0.2% in patients with no risk factors 3.
• Surgical site infection: Research has shown that the use of prophylactic antibiotics in laparoscopic cholecystectomy may not be effective in reducing surgical site infection, with some studies finding no significant difference in infection rates between patients who received antibiotics and those who did not 4, 5.
• Abscess formation: A case report published in 2022 highlighted the risk of abscess formation following open cholecystectomy, which can be due to infection or gallstone spillage during surgery 6.
• Uncontrollable bleeding: A study published in 2023 emphasized the risk of uncontrollable bleeding from the gallbladder bed during laparoscopic cholecystectomy, which can be due to vascular injuries and affects around 0.9-1.9% of cases 7.
• Damage to surrounding tissues: Cholecystectomy carries the risk of damage to surrounding tissues, including the bile ducts and blood vessels.
• Bile leakage: Bile leakage is a potential complication of cholecystectomy, which can lead to infection and other serious consequences.
• Sepsis: Sepsis is a life-threatening condition that can occur as a result of infection following cholecystectomy.