Contents

Search

cholecystectomy

Surgical removal of the gall bladder. Indications: - gallbladder disease - cholecystitis - symptomatic cholelithiasis, biliary colic [7] - gallstones > 3 cm to prevent gallbladder cancer [4] - gallbladder polyps > 1 cm [4] - not indicated for asymptomatic cholelithiasis * laparoscopic cholecystectomy can be safely performed during pregnancy, epecially in the 2nd trimester [4] * using strict criteria for cholecystectomy did not improve pain after 1 year [6] - severe pain attacks - pain lasting at least 15 minutes - pain located in epigastrium or right upper quadrant - pain radiating to the back - positive pain response to simple analgesics * predictors of benefit for symptomatic cholelithiasis include older age, no history of abdominal surgery, pain radiating to back, nausea, no heartburn [7] Procedures: 1) open cholecystectomy 2) laparoscopic cholecystectomy 3) cholangiography to identify common bile duct stones Complications: - injury to the common bile duct - choledocholelithiasis - 20% of patients with recurrent choledocholelithiasis [4] - episodic biliary pain, dilated common bile duct - no signs of peritonitis [4] - ducts of Luschka may be incompletely cauterized or remain unobserved, leading to biliary leak post operatively; biliary peritonitis within 5 to 7 days following surgery, & will require a temporary biliary stent (more common with laparoscopic cholecystectomy) - *** according to ref [4], a bile leak would occur within 1-2 days of surgery, pain would be constant, & signs of peritonitis would be present*** - persistent pain after 4 years in 1/3 of patients [8] Management: - follow-up cholangiography may be needed in patients with recurrent choledocholelithiasis [5]

General

biliary tract surgery

References

  1. Wikipedia: Cholecystectomy http://en.wikipedia.org/wiki/Cholecystectomy
  2. Baron TH, Grimm IS, Swanstrom LL. Interventional Approaches to Gallbladder Disease. N Engl J Med 2015; 373:357-365. July 23, 2015 PMID: 26200981 http://www.nejm.org/doi/full/10.1056/NEJMra1411372
  3. Thistle JL, Longstreth GF, Romero Y et al Factors that predict relief from upper abdominal pain after cholecystectomy. Clin Gastroenterol Hepatol. 2011 Oct;9(10):891-6 PMID: 21699805
  4. Medical Knowledge Self Assessment Program (MKSAP) 17, 19. American College of Physicians, Philadelphia 2015, 2021
  5. Yoo ES, Yoo BM, Kim JH et al. Evaluation of risk factors for recurrent primary common bile duct stone in patients with cholecystectomy. Scand J Gastroenterol 2018 Feb 19 PMID: 29457922 https://www.tandfonline.com/doi/abs/10.1080/00365521.2018.1438507?journalCode=igas20
  6. van Dijk AH, Wennmacker SZ, de Reuver PR et al Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial Lancet. April 26, 2019 PMID: 31036336 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30941-9/fulltext - Guest RV, Soreide K Pain after cholecystectomy for symptomatic gallstones. Lancet. April 26, 2019 PMID: 31036335 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)30959-6/fulltext
  7. Latenstein CSS, Hannink G, van der Bilt JDW et al. A clinical decision tool for selection of patients with symptomatic cholelithiasis for cholecystectomy based on reduction of pain and a pain-free state following surgery. JAMA Surg 2021 Aug 11; 156:e213706. PMID: 34379080 PMCID: PMC8358816 (available on 2022-08-11) https://jamanetwork.com/journals/jamasurgery/article-abstract/2782931
  8. Comes DJ, Wennmacker SZ, Latenstein CSS et al Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones: 5-Year Follow-Up of the SECURE Randomized Clinical Trial. JAMA Surg. 2024 Aug 21:e243080. PMID: 39167382 PMCID: PMC11339699 Free PMC article.
  9. Gallstones and Laparoscopic Cholecystectomy http://consensus.nih.gov/cons/090/090_intro.htm