From the Guidelines
Cholecystectomy is indicated for symptomatic gallstone disease, including biliary colic, acute cholecystitis, gallstone pancreatitis, and choledocholithiasis, as it eliminates the risk of recurrent gallstone-related complications. The procedure is typically performed laparoscopically, which offers faster recovery compared to open surgery 1. According to the 2019 WSES guidelines, cholecystectomy is the preferred treatment for acute cholecystitis, even in elderly patients, and laparoscopic approach should always be attempted at first except in case of absolute anesthetic contraindications and septic shock 2.
Indications for Cholecystectomy
- Symptomatic gallstone disease, including biliary colic, acute cholecystitis, gallstone pancreatitis, and choledocholithiasis
- Gallbladder polyps larger than 1 cm
- Porcelain gallbladder
- Gallbladder cancer
- Asymptomatic gallstones with specific risk factors such as diabetes or immunosuppression
Preoperative Evaluation
- Liver function tests
- Ultrasound imaging
- Possibly MRCP or ERCP if common bile duct stones are suspected
- Patients should fast for at least 8 hours before surgery and discontinue blood thinners as directed 1
Postoperative Care
- Patients can expect to stay in the hospital for 1-2 days for laparoscopic procedures and longer for open surgeries
- Early laparoscopic cholecystectomy should be performed as soon as possible, but can be performed up to 10 days of onset of symptoms, with earlier surgery associated with shorter hospital stay and fewer complications 2
Special Considerations
- In elderly patients, the evaluation of the risk for cholecystectomy should include mortality rate, rate of gallstone-related disease relapse, age-related life expectancy, and patient frailty evaluation by the use of frailty scores 2
- Percutaneous cholecystostomy can be considered in the treatment of acute cholecystitis patients who are deemed unfit for surgery, as a bridge to cholecystectomy in acutely ill patients 2
From the Research
Indications for Cholecystectomy
The indications for a cholecystectomy, or the surgical removal of the gallbladder, include:
- Gallstone-related disease, such as biliary colic, acute cholecystitis, gallstone pancreatitis, and obstructive jaundice 3
- Uncomplicated symptomatic gallstone disease, although a critical view on indications is necessary to prevent unnecessary cholecystectomies 4
- Complicated symptomatic gallstone disease, such as acute cholecystitis, common bile duct stones, and biliary pancreatitis, where same-admission cholecystectomy may reduce the risk of recurrent complications 4
- Chronic cholecystitis, where laparoscopic cholecystectomy may provide better surgical results and improve quality of life 5
- Gallbladder stones 10 mm or larger, or a history of acute pancreatitis, where prophylactic cholecystectomy may be recommended after complete clearance of common bile duct stones 6
- Acute cholecystitis, where early laparoscopic cholecystectomy is associated with improved patient outcomes, including fewer composite postoperative complications and a shorter length of hospital stay 7
Specific Patient Populations
In certain patient populations, the indications for cholecystectomy may vary:
- During pregnancy, early laparoscopic cholecystectomy is recommended to reduce the risk of maternal-fetal complications 7
- In people older than 65 years of age, laparoscopic cholecystectomy is associated with lower mortality at 2-year follow-up compared with nonoperative management 7
- In patients with acalculous acute cholecystitis, percutaneous cholecystostomy tube placement may be reserved for those who are severely ill at the time of diagnosis, while others should undergo laparoscopic cholecystectomy 7