The drug atlas
Surgery & Perioperative/GI / hepatobiliary
Cholecystectomy
also: gallbladder removal · lap chole
Overview
Removal of the gallbladder — for symptomatic gallstone disease.
Mechanism
Laparoscopic removal of the gallbladder. Acute cholecystitis is increasingly managed with early ("hot") rather than delayed ("interval") surgery.
Indications
- Symptomatic gallstones / biliary colic
- Acute cholecystitis (ideally within 1 week — "hot" lap chole)
- Gallstone pancreatitis (same admission), empyema
The agents
Laparoscopicstandard
Convert to open if difficult/Calot triangle unclear.
Hot vs intervaltiming
Early surgery in acute cholecystitis now preferred.
Adverse effects
Bile duct injuryserious
The feared complication.
Bile leakserious
Retained CBD stone (→ ERCP)common
Post-cholecystectomy syndromecommon
Cautions & contraindications
Asymptomatic gallstonesall
Usually not an indication.
Choosing it
Recurrent RUQ pain after fatty meals, or fever with a positive Murphy sign and gallstones on ultrasound.
Source: NICE CG188 — Gallstone disease