- Daniel T Dempsey, MD, FACS
Daniel T Dempsey, MD, FACS
- Professor of Surgery
- University of Pennsylvania
- Perelman School of Medicine
- Shefali Agrawal, MD, FACS
Shefali Agrawal, MD, FACS
- Senior Consultant, Hepatobiliary and Pancreatic Surgery
- Indraprastha Apollo Hospital
Cholecystectomy is one of the most commonly performed abdominal surgical procedures. The laparoscopic approach is preferred due to documented physiologic, economic, and cosmetic benefits compared with the open approach. However, when laparoscopic cholecystectomy is not possible or cannot be completed safely, open cholecystectomy is indicated. Open cholecystectomy may also be performed as an integral part of another operation (eg, pancreaticoduodenectomy) or incidentally, if indicated, during another gastrointestinal operation (eg, colon resection). (See "Laparoscopic cholecystectomy" and "Complications of laparoscopic cholecystectomy".)
This topic will review the technique of open cholecystectomy. Laparoscopic cholecystectomy is discussed in detail elsewhere. (See "Laparoscopic cholecystectomy".)
The indications for a cholecystectomy include:
●Acalculous cholecystitis (see "Acalculous cholecystitis").
- Bragg LE, Thompson JS. Concomitant cholecystectomy for asymptomatic cholelithiasis. Arch Surg 1989; 124:460.
- Juhasz ES, Wolff BG, Meagher AP, et al. Incidental cholecystectomy during colorectal surgery. Ann Surg 1994; 219:467.
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- Kaafarani HM, Smith TS, Neumayer L, et al. Trends, outcomes, and predictors of open and conversion to open cholecystectomy in Veterans Health Administration hospitals. Am J Surg 2010; 200:32.
- Strasberg SM, Gouma DJ. 'Extreme' vasculobiliary injuries: association with fundus-down cholecystectomy in severely inflamed gallbladders. HPB (Oxford) 2012; 14:1.
- Horn T, Christensen SD, Kirkegård J, et al. Percutaneous cholecystostomy is an effective treatment option for acute calculous cholecystitis: a 10-year experience. HPB (Oxford) 2015; 17:326.
- Ingraham AM, Cohen ME, Ko CY, Hall BL. A current profile and assessment of north american cholecystectomy: results from the american college of surgeons national surgical quality improvement program. J Am Coll Surg 2010; 211:176.
- Jenkins JT, Williamson BW. Prospective study to develop an algorithm for investigation by endoscopic retrograde cholangiopancreatography or magnetic resonance cholangiopancreatography. ANZ J Surg 2006; 76:977.
- Bratzler DW, Dellinger EP, Olsen KM, et al. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm 2013; 70:195.
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- Lundström P, Sandblom G, Osterberg J, et al. Effectiveness of prophylactic antibiotics in a population-based cohort of patients undergoing planned cholecystectomy. J Gastrointest Surg 2010; 14:329.
- Darkahi B, Videhult P, Sandblom G, et al. Effectiveness of antibiotic prophylaxis in cholecystectomy: a prospective population-based study of 1171 cholecystectomies. Scand J Gastroenterol 2012; 47:1242.
- Sanabria A, Dominguez LC, Valdivieso E, Gomez G. Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy. Cochrane Database Syst Rev 2010; :CD005265.
- Choudhary A, Bechtold ML, Puli SR, et al. Role of prophylactic antibiotics in laparoscopic cholecystectomy: a meta-analysis. J Gastrointest Surg 2008; 12:1847.
- Lee WJ, Chang KJ, Lee CS, Chen KM. Surgery in cholangitis: bacteriology and choice of antibiotic. Hepatogastroenterology 1992; 39:347.
- Kanter MA, Geelhoed GW. Biliary antibiotics: clinical utility in biliary surgery. South Med J 1987; 80:1007.
- Lewis RT, Goodall RG, Marien B, et al. Biliary bacteria, antibiotic use, and wound infection in surgery of the gallbladder and common bile duct. Arch Surg 1987; 122:44.
- Pilgrim CH, Usatoff V, Evans P. Consideration of anatomical structures relevant to the surgical strategy for managing gallbladder carcinoma. Eur J Surg Oncol 2009; 35:1131.
- Savas JF, Litwack R, Davis K, Miller TA. Regional anesthesia as an alternative to general anesthesia for abdominal surgery in patients with severe pulmonary impairment. Am J Surg 2004; 188:603.
- 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.
- Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg 1995; 180:101.
- Gurusamy KS, Samraj K, Mullerat P, Davidson BR. Routine abdominal drainage for uncomplicated laparoscopic cholecystectomy. Cochrane Database Syst Rev 2007; :CD006004.
- Lewis RT, Goodall RG, Marien B, et al. Simple elective cholecystectomy: to drain or not. Am J Surg 1990; 159:241.
- Monson JR, Guillou PJ, Keane FB, et al. Cholecystectomy is safer without drainage: the results of a prospective, randomized clinical trial. Surgery 1991; 109:740.
- Zaydfudim V, Russell RT, Feurer ID, et al. Drain use after open cholecystectomy: is there a justification? Langenbecks Arch Surg 2009; 394:1011.
- Indications for open surgery
- - Conversion from laparoscopic operation
- - Absolute indications for open surgery
- - Relative indications for open surgery
- PREOPERATIVE EVALUATION
- Laboratory testing
- Preoperative imaging
- Prophylactic antibiotics
- GALLBLADDER ANATOMY
- OPEN CHOLECYSTECTOMY PROCEDURE
- Exposing the gallbladder
- Gallbladder dissection and removal
- - Top-down approach
- - Bottom-up approach
- - Unusual situations
- Intraoperative cholangiography
- Common bile duct exploration
- OPEN CHOLECYSTOSTOMY TUBE PLACEMENT
- POSTOPERATIVE CARE AND FOLLOW-UP
- PERIOPERATIVE MORBIDITY AND MORTALITY
- Bile leak
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS