Laparoscopic Cholecystectomy

Miguel A. Burch, MD
Student Author:
Student Name

Background Information:

Cholecystectomy is the removal of the gallbladder. This procedure may be performed via the open procedure or minimally invasive (laparoscopically or robotically).

Indications:

  • Cholecystitis
  • Symptomatic cholelithiasis (biliary colic)
  • Choledocholithiasis
  • Gallbladder pancreatitis
  • Gallstone ileus
  • Gallbladder cancer
  • Gallbladder polyps >5cm
  • Porcelain gallbladder

Key Anatomy:

  • Gall bladder
  • Triangle of Calot’s (cystic triangle)
  • Calot’s (cystic) lymph node
  • Cystic artery
  • Cystic duct
  • Common bile duct
  • Common hepatic duct
  • Rouviere’s sulcus

Surgical Risks:

General surgical risks:

  • Bleeding
  • Infection

Risks specific to Cholecystectomy

  • Common bile duct injury (0.22% incidence for laparoscopic repair according to Fong et al. 2018)
  • Bile leak from the transected cystic duct (0.5% incidence for laparoscopic repair according to Fong et al. 2018)
  • Enterotomy
  • 0.22% incidence for laparoscopic surgery (van der Voort et al., 2004)
  • Postoperative ileus
  • Risk lower for minimally invasive procedures vs. open

ACS/ASC Core Curriculum

Osmosis:

Online MedEd:

Text:

  • Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice by Courtney M. Townsend Jr. JR. MD
  • Zollinger’s Atlas of Surgical Operations, Tenth Edition 10th Edition

by Robert Zollinger, E. Ellison

  • Atlas of General Surgical Techniques: Townsend, Evers
  • Essentials of General Surgery 5th Edition, by Peter F. Lawrence MD, Richard M. Bell MD, Merril T. Dayton MD, James C. Hebert MD FACS

Other:


  1. Fong ZV, Pitt HA, Strasberg SM, et al. Diminished Survival in Patients with Bile Leak and Ductal Injury: Management Strategy and Outcomes. J Am Coll Surg. 2018;226(4):568-576.e1. doi:10.1016/j.jamcollsurg.2017.12.023
  2. Townsend CM, Sabiston DC. Sabiston Textbook of Surgery E-Book [Internet]. Vol. 19th ed. Philadelphia, PA: Saunders; 2012.
  3. van der Voort M, Heijnsdijk EA, Gouma DJ. Bowel injury as a complication of laparoscopy. Br J Surg. 2004;91(10):1253-1258. doi:10.1002/bjs.4716