From the Guidelines
Preoperative Clearance for Cholecystectomy Requirements
An exhaustive preoperative work-up is mandatory before cholecystectomy to detect at-risk conditions, choose the best surgical approach, and discuss the risks/benefits ratio of the procedure 1.
Key Components of Preoperative Clearance
- Assessment of the patient's clinical status: Including evaluation of mortality rate for conservative and surgical therapeutic options, rate of gallstone-related disease relapse, age-related life expectancy, and patient frailty evaluation using frailty scores 1.
- Disease factors assessment: Such as the presence of scleroatrophic cholecystitis, Mirizzi syndrome, and other conditions that may increase the risk of bile duct injury 1.
- Imaging studies: Abdominal ultrasound is the preferred initial imaging technique for patients suspected of having acute cholecystitis, due to its lower cost, better availability, lack of invasiveness, and good accuracy for stones 1.
- Laboratory tests: Including liver biochemical tests, such as ALT, AST, bilirubin, ALP, and GGT, to assess the risk for common bile duct stones 1.
- Surgical risk assessment: Using surgical clinical scores to estimate specific risk (patient/type of surgery) 1.
Special Considerations
- Elderly patients: Old age (> 65 years) does not represent a contraindication to cholecystectomy for acute cholecystitis, and laparoscopic approach should always be attempted at first, except in case of absolute anesthetic contraindications and septic shock 1.
- High-risk patients: Percutaneous cholecystostomy can be considered as a bridge to cholecystectomy in acutely ill (high-risk) patients deemed unfit for surgery, to convert them into moderate risk patients, more suitable for surgery 1.
From the Research
Preoperative Clearance Requirements for Cholecystectomy
The requirements for preoperative clearance for cholecystectomy (gallbladder removal) include:
- Evaluation of the patient's overall health and medical history, including any underlying cardiovascular disease 2
- Laboratory tests, such as hemogram parameters and derived ratios, although their predictive value for conversion to open cholecystectomy is limited 3
- Imaging studies, such as preoperative ultrasound to evaluate the gallbladder and bile ducts 4
- Assessment of the patient's risk factors for conversion to open cholecystectomy, such as inflammation, adhesions, and common-bile-duct stones 4
Patient Characteristics and Disease Condition
Patient characteristics and disease condition can inform the consideration of alternative operative approaches, including:
- Age and sex of the patient 2
- Presence of severe cardiovascular disease 2
- Presence of acute or chronic cholecystitis 4
- Presence of common-bile-duct stones 4
Preoperative Preparation
Preoperative preparation is crucial to ensure a safe and successful surgery, including: