RT Book, Section
A1 Ellison, E. Christopher
A1 Zollinger, Jr., Robert M.
A1 Pawlik, Timothy M.
A1 Vaccaro, Patrick S.
A1 Bitans, Marita
A1 Baker, Anthony S.
SR Print(0)
ID 1187822134
T1 Cholecystectomy, Laparoscopic
T2 Zollinger’s Atlas of Surgical Operations, 11e
YR 2022
FD 2022
PB McGraw-Hill Education
PP New York, NY
SN 9781260440850
LK accesssurgery.mhmedical.com/content.aspx?aid=1187822134
RD 2024/04/25
AB The  indications  for  laparoscopic  cholecystectomy  are  similar  to  those  for  open  cholecystectomy.  These  include,  but  are  not  limited  to,  symptomatic  cholelithiasis,  acute  calculus  and  acalculous  cholecystitis,  gallstone  pancreatitis,  biliary  dyskinesia,  and  gallbladder  masses  and  polyps  that  are  concerning  for  malignancies.  Cholecystectomy  for  mild  gallstone  pancreatitis  should  be  performed  during  the  initial  admission  for  pancreatitis  and  deferred  for  several  weeks  in  patients  with  severe  pancreatitis.  Contraindications  to  laparoscopic  cholecystectomy  include  small  bowel  obstruction  secondary  to  gallstone  ileus  (which  would  mandate  an  open  surgical  approach),  coagulopathy,  and  medical  comorbidities  prohibiting  surgery.  Relative  contraindications  to  a  laparoscopic  approach,  primarily  previous  intra-abdominal  surgery  resulting  in  adhesions  and  severe  cholecystitis,  are  decreasing  as  surgeon  experience  with  minimally  invasive  surgery  increases.  Factors  associated  with  increased  surgical  risk  include  older  age,  specific  medical  comorbidities  such  as  diabetes  mellitus,  male  sex,  cirrhosis  with  or  without  portal  hypertension,  and  acute  gangrenous  cholecystitis.