UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Laparoscopic cholecystectomy

Authors
Nathaniel J Soper, MD, FACS
Preeti Malladi, MD
Section Editor
Stanley W Ashley, MD
Deputy Editor
Wenliang Chen, MD, PhD

INTRODUCTION

Cholecystectomy is one of the most commonly performed abdominal surgical procedures, and in developed countries many are performed laparoscopically. As an example, 90 percent of cholecystectomies in the United States are performed laparoscopically [1]. Laparoscopic cholecystectomy is considered the "gold standard" for the surgical treatment of gallstone disease. This procedure results in less postoperative pain, better cosmesis, shorter hospital stays and disability from work than open cholecystectomy [2-8]. However, the overall serious complication rate in laparoscopic cholecystectomy remains higher than that seen in open cholecystectomy [9,10]. (See "Complications of laparoscopic cholecystectomy".)

This topic will discuss the technique of laparoscopic cholecystectomy. The diagnosis and overall treatment approach to cholecystitis is discussed elsewhere in detail. (See "Acute cholecystitis: Pathogenesis, clinical features, and diagnosis" and "Treatment of acute calculous cholecystitis".)

INDICATIONS

The indications for laparoscopic cholecystectomy are the same as for open cholecystectomy:

Symptomatic cholelithiasis with, or without, complications (see "Treatment of acute calculous cholecystitis" and "Uncomplicated gallstone disease in adults").

Asymptomatic cholelithiasis in patients who are at increased risk for gallbladder carcinoma or gallstone complications (see "Approach to the patient with incidental gallstones").

                                      

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Thu Oct 13 00:00:00 GMT 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Csikesz NG, Singla A, Murphy MM, et al. Surgeon volume metrics in laparoscopic cholecystectomy. Dig Dis Sci 2010; 55:2398.
  2. Soper NJ, Stockmann PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy. The new 'gold standard'? Arch Surg 1992; 127:917.
  3. Schirmer BD, Edge SB, Dix J, et al. Laparoscopic cholecystectomy. Treatment of choice for symptomatic cholelithiasis. Ann Surg 1991; 213:665.
  4. Wiesen SM, Unger SW, Barkin JS, et al. Laparoscopic cholecystectomy: the procedure of choice for acute cholecystitis. Am J Gastroenterol 1993; 88:334.
  5. Wilson RG, Macintyre IM, Nixon SJ, et al. Laparoscopic cholecystectomy as a safe and effective treatment for severe acute cholecystitis. BMJ 1992; 305:394.
  6. Rattner DW, Ferguson C, Warshaw AL. Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1993; 217:233.
  7. Johansson M, Thune A, Nelvin L, et al. Randomized clinical trial of open versus laparoscopic cholecystectomy in the treatment of acute cholecystitis. Br J Surg 2005; 92:44.
  8. Yamashita Y, Takada T, Kawarada Y, et al. Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines. J Hepatobiliary Pancreat Surg 2007; 14:91.
  9. Vollmer CM Jr, Callery MP. Biliary injury following laparoscopic cholecystectomy: why still a problem? Gastroenterology 2007; 133:1039.
  10. Khan MH, Howard TJ, Fogel EL, et al. Frequency of biliary complications after laparoscopic cholecystectomy detected by ERCP: experience at a large tertiary referral center. Gastrointest Endosc 2007; 65:247.
  11. Keus F, Broeders IA, van Laarhoven CJ. Gallstone disease: Surgical aspects of symptomatic cholecystolithiasis and acute cholecystitis. Best Pract Res Clin Gastroenterol 2006; 20:1031.
  12. Sinha R, Gurwara AK, Gupta SC. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A 2009; 19:323.
  13. Steinert R, Nestler G, Sagynaliev E, et al. Laparoscopic cholecystectomy and gallbladder cancer. J Surg Oncol 2006; 93:682.
  14. Lo CM, Liu CL, Fan ST, et al. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 1998; 227:461.
  15. Gurusamy K, Samraj K, Gluud C, et al. Meta-analysis of randomized controlled trials on the safety and effectiveness of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Br J Surg 2010; 97:141.
  16. Gutt CN, Encke J, Köninger J, et al. Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg 2013; 258:385.
  17. Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev 2010; :CD005265.
  18. Yan RC, Shen SQ, Chen ZB, et al. The role of prophylactic antibiotics in laparoscopic cholecystectomy in preventing postoperative infection: a meta-analysis. J Laparoendosc Adv Surg Tech A 2011; 21:301.
  19. Procter LD, Davenport DL, Bernard AC, Zwischenberger JB. General surgical operative duration is associated with increased risk-adjusted infectious complication rates and length of hospital stay. J Am Coll Surg 2010; 210:60.
  20. Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38:1706.
  21. Fry DE. Surgical site infections and the surgical care improvement project (SCIP): evolution of national quality measures. Surg Infect (Larchmt) 2008; 9:579.
  22. Varela JE, Wilson SE, Nguyen NT. Laparoscopic surgery significantly reduces surgical-site infections compared with open surgery. Surg Endosc 2010; 24:270.
  23. Siddiqui K, Khan AF. Comparison of frequency of wound infection: open vs laparoscopic cholecystectomy. J Ayub Med Coll Abbottabad 2006; 18:21.
  24. Matsui Y, Satoi S, Kaibori M, et al. Antibiotic prophylaxis in laparoscopic cholecystectomy: a randomized controlled trial. PLoS One 2014; 9:e106702.
  25. Chang WT, Lee KT, Chuang SC, et al. The impact of prophylactic antibiotics on postoperative infection complication in elective laparoscopic cholecystectomy: a prospective randomized study. Am J Surg 2006; 191:721.
  26. Koc M, Zulfikaroglu B, Kece C, Ozalp N. A prospective randomized study of prophylactic antibiotics in elective laparoscopic cholecystectomy. Surg Endosc 2003; 17:1716.
  27. Zhou H, Zhang J, Wang Q, Hu Z. Meta-analysis: Antibiotic prophylaxis in elective laparoscopic cholecystectomy. Aliment Pharmacol Ther 2009; 29:1086.
  28. Choudhary A, Bechtold ML, Puli SR, et al. Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg 2008; 12:1847.
  29. Pasquali S, Boal M, Griffiths EA, et al. Meta-analysis of perioperative antibiotics in patients undergoing laparoscopic cholecystectomy. Br J Surg 2016; 103:27.
  30. Sharma N, Garg PK, Hadke NS, Choudhary D. Role of prophylactic antibiotics in laparoscopic cholecystectomy and risk factors for surgical site infection: a randomized controlled trial. Surg Infect (Larchmt) 2010; 11:367.
  31. Bratzler DW, Hunt DR. The surgical infection prevention and surgical care improvement projects: national initiatives to improve outcomes for patients having surgery. Clin Infect Dis 2006; 43:322.
  32. Kaufman Z, Engelberg M, Eliashiv A, Reiss R. Systemic prophylactic antibiotics in elective biliary surgery. Arch Surg 1984; 119:1002.
  33. Meijer WS, Schmitz PI, Jeekel J. Meta-analysis of randomized, controlled clinical trials of antibiotic prophylaxis in biliary tract surgery. Br J Surg 1990; 77:283.
  34. Baquero F, Hsueh PR, Paterson DL, et al. In vitro susceptibilities of aerobic and facultatively anaerobic gram-negative bacilli isolated from patients with intra-abdominal infections worldwide: 2005 results from Study for Monitoring Antimicrobial Resistance Trends (SMART). Surg Infect (Larchmt) 2009; 10:99.
  35. Persson G, Strömberg J, Svennblad B, Sandblom G. Risk of bleeding associated with use of systemic thromboembolic prophylaxis during laparoscopic cholecystectomy. Br J Surg 2012; 99:979.
  36. Matsui Y, Hirooka S, Ryota H, et al. Safety of laparoscopic cholecystectomy after coronary artery bypass with the right gastroepiploic artery. Surgery 2016; 160:252.
  37. Avgerinos C, Kelgiorgi D, Touloumis Z, et al. One thousand laparoscopic cholecystectomies in a single surgical unit using the "critical view of safety" technique. J Gastrointest Surg 2009; 13:498.
  38. Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180:101.
  39. Stiegmann GV, Soper NJ, Filipi CJ, et al. Laparoscopic ultrasonography as compared with static or dynamic cholangiography at laparoscopic cholecystectomy. A prospective multicenter trial. Surg Endosc 1995; 9:1269.
  40. Machi J, Johnson JO, Deziel DJ, et al. The routine use of laparoscopic ultrasound decreases bile duct injury: a multicenter study. Surg Endosc 2009; 23:384.
  41. Gurusamy KS, Koti R, Davidson BR. Routine abdominal drainage versus no abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 2013; :CD006004.
  42. Tonouchi H, Ohmori Y, Kobayashi M, Kusunoki M. Trocar site hernia. Arch Surg 2004; 139:1248.
  43. Loizides S, Gurusamy KS, Nagendran M, et al. Wound infiltration with local anaesthetic agents for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2014; :CD007049.
  44. Thakur V, Schlachta CM, Jayaraman S. Minilaparoscopic versus conventional laparoscopic cholecystectomy a systematic review and meta-analysis. Ann Surg 2011; 253:244.
  45. Hosono S, Osaka H. Minilaparoscopic versus conventional laparoscopic cholecystectomy: a meta-analysis of randomized controlled trials. J Laparoendosc Adv Surg Tech A 2007; 17:191.
  46. Marks JM, Phillips MS, Tacchino R, et al. Single-incision laparoscopic cholecystectomy is associated with improved cosmesis scoring at the cost of significantly higher hernia rates: 1-year results of a prospective randomized, multicenter, single-blinded trial of traditional multiport laparoscopic cholecystectomy vs single-incision laparoscopic cholecystectomy. J Am Coll Surg 2013; 216:1037.
  47. Pan MX, Jiang ZS, Cheng Y, et al. Single-incision vs three-port laparoscopic cholecystectomy: prospective randomized study. World J Gastroenterol 2013; 19:394.
  48. Hodgett SE, Hernandez JM, Morton CA, et al. Laparoendoscopic single site (LESS) cholecystectomy. J Gastrointest Surg 2009; 13:188.
  49. Marks J, Tacchino R, Roberts K, et al. Prospective randomized controlled trial of traditional laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy: report of preliminary data. Am J Surg 2011; 201:369.
  50. Joseph M, Phillips MR, Farrell TM, Rupp CC. Single incision laparoscopic cholecystectomy is associated with a higher bile duct injury rate: a review and a word of caution. Ann Surg 2012; 256:1.
  51. Pietrabissa A, Sbrana F, Morelli L, et al. Overcoming the challenges of single-incision cholecystectomy with robotic single-site technology. Arch Surg 2012; 147:709.
  52. Saad S, Strassel V, Sauerland S. Randomized clinical trial of single-port, minilaparoscopic and conventional laparoscopic cholecystectomy. Br J Surg 2013; 100:339.
  53. Phillips MS, Marks JM, Roberts K, et al. Intermediate results of a prospective randomized controlled trial of traditional four-port laparoscopic cholecystectomy versus single-incision laparoscopic cholecystectomy. Surg Endosc 2012; 26:1296.
  54. Philipp SR, Miedema BW, Thaler K. Single-incision laparoscopic cholecystectomy using conventional instruments: early experience in comparison with the gold standard. J Am Coll Surg 2009; 209:632.
  55. Ponsky TA. Single port laparoscopic cholecystectomy in adults and children: tools and techniques. J Am Coll Surg 2009; 209:e1.
  56. Lirici MM, Califano AD, Angelini P, Corcione F. Laparo-endoscopic single site cholecystectomy versus standard laparoscopic cholecystectomy: results of a pilot randomized trial. Am J Surg 2011; 202:45.
  57. Tsimoyiannis EC, Tsimogiannis KE, Pappas-Gogos G, et al. Different pain scores in single transumbilical incision laparoscopic cholecystectomy versus classic laparoscopic cholecystectomy: a randomized controlled trial. Surg Endosc 2010; 24:1842.
  58. Love KM, Durham CA, Meara MP, et al. Single-incision laparoscopic cholecystectomy: a cost comparison. Surg Endosc 2011; 25:1553.
  59. Bucher P, Pugin F, Buchs NC, et al. Randomized clinical trial of laparoendoscopic single-site versus conventional laparoscopic cholecystectomy. Br J Surg 2011; 98:1695.
  60. Ma J, Cassera MA, Spaun GO, et al. Randomized controlled trial comparing single-port laparoscopic cholecystectomy and four-port laparoscopic cholecystectomy. Ann Surg 2011; 254:22.
  61. Sajid MS, Ladwa N, Kalra L, et al. Single-incision laparoscopic cholecystectomy versus conventional laparoscopic cholecystectomy: meta-analysis and systematic review of randomized controlled trials. World J Surg 2012; 36:2644.
  62. Leung D, Yetasook AK, Carbray J, et al. Single-incision surgery has higher cost with equivalent pain and quality-of-life scores compared with multiple-incision laparoscopic cholecystectomy: a prospective randomized blinded comparison. J Am Coll Surg 2012; 215:702.
  63. Chuang SH, Lin CS. Single-incision laparoscopic surgery for biliary tract disease. World J Gastroenterol 2016; 22:736.
  64. Rattner D, Kalloo A, ASGE/SAGES Working Group. ASGE/SAGES Working Group on Natural Orifice Translumenal Endoscopic Surgery. October 2005. Surg Endosc 2006; 20:329.
  65. Marescaux J, Dallemagne B, Perretta S, et al. Surgery without scars: report of transluminal cholecystectomy in a human being. Arch Surg 2007; 142:823.
  66. Zornig C, Emmermann A, von Waldenfels HA, Mofid H. Laparoscopic cholecystectomy without visible scar: combined transvaginal and transumbilical approach. Endoscopy 2007; 39:913.
  67. Zorrón R, Filgueiras M, Maggioni LC, et al. NOTES. Transvaginal cholecystectomy: report of the first case. Surg Innov 2007; 14:279.
  68. Bulian DR, Knuth J, Cerasani N, et al. Transvaginal/transumbilical hybrid--NOTES--versus 3-trocar needlescopic cholecystectomy: short-term results of a randomized clinical trial. Ann Surg 2015; 261:451.
  69. Wood SG, Solomon D, Panait L, et al. Transvaginal cholecystectomy: effect on quality of life and female sexual function. JAMA Surg 2013; 148:435.
  70. Hamad MA, Thabet M, Badawy A, et al. Laparoscopic versus open cholecystectomy in patients with liver cirrhosis: a prospective, randomized study. J Laparoendosc Adv Surg Tech A 2010; 20:405.
  71. Quillin RC 3rd, Burns JM, Pineda JA, et al. Laparoscopic cholecystectomy in the cirrhotic patient: predictors of outcome. Surgery 2013; 153:634.
  72. Bessa SS, Abdel-Razek AH, Sharaan MA, et al. Laparoscopic cholecystectomy in cirrhotics: a prospective randomized study comparing the conventional diathermy and the harmonic scalpel for gallbladder dissection. J Laparoendosc Adv Surg Tech A 2011; 21:1.
  73. Poggio JL, Rowland CM, Gores GJ, et al. A comparison of laparoscopic and open cholecystectomy in patients with compensated cirrhosis and symptomatic gallstone disease. Surgery 2000; 127:405.
  74. Jorge AM, Keswani RN, Veerappan A, et al. Non-operative management of symptomatic cholelithiasis in pregnancy is associated with frequent hospitalizations. J Gastrointest Surg 2015; 19:598.
  75. Soper NJ, Hunter JG, Petrie RH. Laparoscopic cholecystectomy during pregnancy. Surg Endosc 1992; 6:115.
  76. Guidelines Committee of the Society of American Gastrointestinal and Endoscopic Surgeons, Yumi H. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy: this statement was reviewed and approved by the Board of Governors of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), September 2007. It was prepared by the SAGES Guidelines Committee. Surg Endosc 2008; 22:849.
  77. Guidelines for laparoscopic surgery during pregnancy. Surg Endosc 1998; 12:189.
  78. Curet MJ. Special problems in laparoscopic surgery. Previous abdominal surgery, obesity, and pregnancy. Surg Clin North Am 2000; 80:1093.
  79. Simopoulos C, Botaitis S, Karayiannakis AJ, et al. The contribution of acute cholecystitis, obesity, and previous abdominal surgery on the outcome of laparoscopic cholecystectomy. Am Surg 2007; 73:371.
  80. Mahmud S, Masaud M, Canna K, Nassar AH. Fundus-first laparoscopic cholecystectomy. Surg Endosc 2002; 16:581.
  81. Philips JA, Lawes DA, Cook AJ, et al. The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc 2008; 22:1697.
  82. Beldi G, Glättli A. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc 2003; 17:1437.
  83. Jones DB, Dunnegan DL, Soper NJ. The influence of intraoperative gallbladder perforation on long-term outcome after laparoscopic cholecystectomy. Surg Endosc 1995; 9:977.
  84. Deziel DJ, Millikan KW, Economou SG, et al. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993; 165:9.
  85. Carlin CB, Kent RB Jr, Laws HL. Spilled gallstones--complications of abdominal-wall abscesses. Case report and review of the literature. Surg Endosc 1995; 9:341.
  86. Horton M, Florence MG. Unusual abscess patterns following dropped gallstones during laparoscopic cholecystectomy. Am J Surg 1998; 175:375.
  87. Zamir G, Lyass S, Pertsemlidis D, Katz B. The fate of the dropped gallstones during laparoscopic cholecystectomy. Surg Endosc 1999; 13:68.
  88. Ishizawa T, Bandai Y, Kokudo N. Fluorescent cholangiography using indocyanine green for laparoscopic cholecystectomy: an initial experience. Arch Surg 2009; 144:381.
  89. Pertsemlidis D, Barzilai A, Persemlidis DS, et al. Enhanced laparoscopic visualization of the extrahepatic bile duct with intravenous indocyanine green [abstract]. Am J Gastroenterol 1993; 88:1583.
  90. Vaughan J, Gurusamy KS, Davidson BR. Day-surgery versus overnight stay surgery for laparoscopic cholecystectomy. Cochrane Database Syst Rev 2013; :CD006798.
  91. Vaughan J, Nagendran M, Cooper J, et al. Anaesthetic regimens for day-procedure laparoscopic cholecystectomy. Cochrane Database Syst Rev 2014; :CD009784.
  92. Rao A, Polanco A, Qiu S, et al. Safety of outpatient laparoscopic cholecystectomy in the elderly: analysis of 15,248 patients using the NSQIP database. J Am Coll Surg 2013; 217:1038.
  93. Jaunoo SS, Mohandas S, Almond LM. Postcholecystectomy syndrome (PCS). Int J Surg 2010; 8:15.
  94. Girometti R, Brondani G, Cereser L, et al. Post-cholecystectomy syndrome: spectrum of biliary findings at magnetic resonance cholangiopancreatography. Br J Radiol 2010; 83:351.
  95. Lamberts MP, Den Oudsten BL, Gerritsen JJ, et al. Prospective multicentre cohort study of patient-reported outcomes after cholecystectomy for uncomplicated symptomatic cholecystolithiasis. Br J Surg 2015; 102:1402.