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 2024/11/03 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.