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Chapter 57 - Cholecystectomy

from Section 17 - General Surgery

Published online by Cambridge University Press:  05 September 2013

Michael F. Lubin
Affiliation:
Emory University, Atlanta
Thomas F. Dodson
Affiliation:
Emory University, Atlanta
Neil H. Winawer
Affiliation:
Emory University, Atlanta
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Summary

Cholecystectomy is indicated for symptomatic calculous cholecystitis (acute or chronic); acalculous acute cholecystitis; a gallbladder that releases stones into the common bile duct (obstructive jaundice, gallstone pancreatitis, cholangitis); carcinoma of the gallbladder; traumatic perforation of the gallbladder; and biliary dyskinesia (low gallbladder ejection fraction). It is also performed after right hepatic artery ligation for hepatic trauma and in preparation for infusion of the hepatic artery with chemotherapeutic agents for metastases. It is included as part of a pancreatoduodenectomy and may be necessary for exposure of the porta hepatis in some patients undergoing portacaval shunt procedures.

Cholecystectomy can best be performed within 48 hours of admission for patients with acute cholecystitis documented on ultrasonography or radionuclide scanning (i.e., HIDA scan) unless general anesthesia is contraindicated. In patients with acute cholecystitis of longer duration, the extent of inflammation may make a laparoscopic approach difficult. If cholecystectomy is to be scheduled electively for acute cholecystitis, it is appropriate to give antibiotics until the time of surgery to help the inflammation subside. Patients with obstructive jaundice, gallstone pancreatitis, or cholangitis undergo cholecystectomy after observation to determine whether the bilirubin level will fall, when the amylase level returns to normal, and when hemodynamic stability has been restored, respectively.

Type
Chapter
Information
Medical Management of the Surgical Patient
A Textbook of Perioperative Medicine
, pp. 531 - 532
Publisher: Cambridge University Press
Print publication year: 2013

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References

Banz, V, Gsponer, T, Candinas, D, Güller, U.Population-based analysis of 4113 patients with acute cholecystitis: defining the optimal time-point for laparoscopic cholecystectomy. Ann Surg 2011; 254: 964–70.CrossRefGoogle ScholarPubMed
Csikesz, NG, Tseng, JF, Shah, SA.Trends in surgical management for acute cholecystitis. Surgery 2008; 144(2): 283–9.CrossRefGoogle ScholarPubMed
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Flum, DR, Dellinger, EP, Cheadle, A et al. Intraoperative cholangiography and risk of common bile duct injury during cholecystectomy. J Am Med Assoc 2003; 289: 1639–44.CrossRefGoogle ScholarPubMed
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: 32–40.CrossRefGoogle ScholarPubMed
Pfluke, JM, Parker, M, Stauffer, JA et al. Laparoscopic surgery performed through a single incision: a systematic review of the current literature. J Am Coll Surg 2011; 212: 113–18.CrossRefGoogle ScholarPubMed
Sakpal, SV, Bindra, SS, Chamberlain, RS.Laparoscopic cholecystectomy conversion rates two decades later. J Soc Laparoendosc Surg 2010; 14: 476–83.CrossRefGoogle ScholarPubMed

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