- 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").
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- 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.
- 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.
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- 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.
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- Strasberg SM, Gouma DJ. 'Extreme' vasculobiliary injuries: association with fundus-down cholecystectomy in severely inflamed gallbladders. HPB (Oxford) 2012; 14:1.
- 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.
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- 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.
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- 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