Cholecystectomy - Wikipedia

Cholecystectomy is the surgical removal of the gallbladder. Cholecystectomy is a common treatment of symptomatic gallstones and other gallbladder conditions. Cholecystectomy FromWikipedia,thefreeencyclopedia Jumptonavigation Jumptosearch Surgicalremovalofthegallbladder CholecystectomyAUSNavygeneralsurgeonandanoperatingroomnurseperformingalaparoscopiccholecystectomyPronunciation/ˌkɒləsɪsˈtɛktəmi/ICD-9-CM575.0MeSHD002763[editonWikidata] Cholecystectomyisthesurgicalremovalofthegallbladder.Cholecystectomyisacommontreatmentofsymptomaticgallstonesandothergallbladderconditions.[1]In2011,cholecystectomywastheeighthmostcommonoperatingroomprocedureperformedinhospitalsintheUnitedStates.[2]Cholecystectomycanbeperformedeitherlaparoscopically,orviaanopensurgicaltechnique.[3][page needed] Thesurgeryisusuallysuccessfulinrelievingsymptoms,butupto10%ofpeoplemaycontinuetoexperiencesimilarsymptomsaftercholecystectomy,aconditioncalledpostcholecystectomysyndrome.[4]Complicationsofcholecystectomyincludebileductinjury,woundinfection,bleeding,retainedgallstones,abscessformationandstenosis(narrowing)ofthebileduct.[4] Contents 1Medicaluse 1.1Biliarycolic 1.2Acutecholecystitis 1.3Cholangitisandgallstonepancreatitis 1.4Gallbladdercancer 1.5Livertransplantation 2Contraindications 3Risks 3.1Biliaryinjury 3.2Othercomplications 3.3Conversiontoopencholecystectomy 4Procedure 4.1Pre-operativepreparation 4.2Laparoscopiccholecystectomy 4.2.1Singleincision 4.2.2Naturalorificetransluminal 4.3Opencholecystectomy 4.4Biopsy 4.5Post-operativemanagement 5Long-termprognosis 6Considerations 6.1Pregnancy 6.2Porcelaingallbladder 7Alternativestosurgery 7.1Conservativemanagement 7.2ERCP 7.3Cholecystostomy 8Frequencyofuse 9History 9.1Laparoscopictechnique 10Seealso 11References 12Furtherreading Medicaluse[edit] Gallbladderanatomy Painandcomplicationscausedbygallstonesarethemostcommonreasonsforremovalofthegallbladder.[5]Thegallbladdercanalsoberemovedinordertotreatbiliarydyskinesiaorgallbladdercancer.[6] Gallstonesareverycommonbut50–80%ofpeoplewithgallstonesareasymptomaticanddonotneedsurgery;theirstonesarenoticedincidentallyonimagingtestsoftheabdomen(suchasultrasoundorCT)doneforsomeotherreason.[7]Ofthemorethan20millionpeopleintheUSwithgallstones,onlyabout30%willeventuallyrequirecholecystectomytorelievesymptoms(pain)ortreatcomplications.[8] Biliarycolic[edit] Biliarycolic,orpaincausedbygallstones,occurswhenagallstonetemporarilyblocksthebileductthatdrainsthegallbladder.[9]Typically,painfrombiliarycolicisfeltintherightupperpartoftheabdomen,ismoderatetosevere,andgoesawayonitsownafterafewhourswhenthestonedislodges.[10]Biliarycolicusuallyoccursaftermealswhenthegallbladdercontractstopushbileoutintothedigestivetract.Afterafirstattackofbiliarycolic,morethan90%ofpeoplewillhavearepeatattackinthenext10years.[1]Repeatedattacksofbiliarycolicarethemostcommonreasonforremovingthegallbladder,andleadtoabout300,000cholecystectomiesintheUSeachyear.[8][11] Acutecholecystitis[edit] Cholecystitis,orinflammationofthegallbladdercausedbyinterruptioninthenormalflowofbile,isanotherreasonforcholecystectomy.[12]Itisthemostcommoncomplicationofgallstones;90–95%ofacutecholecystitisiscausedbygallstonesblockingdrainageofthegallbladder.[13]Iftheblockageisincompleteandthestonepassesquickly,thepersonexperiencesbiliarycolic.Ifthegallbladderiscompletelyblockedandremainssoforaprolongedperiod,thepersondevelopsacutecholecystitis.[14] Painincholecystitisissimilartothatofbiliarycolic,butlastslongerthansixhoursandoccurstogetherwithsignsofinfectionsuchasfever,chills,oranelevatedwhitebloodcellcount.[1]PeoplewithcholecystitiswillalsousuallyhaveapositiveMurphysignonphysicalexam–meaningthatwhenadoctorasksthepatienttotakeadeepbreathandthenpushesdownontheupperrightsideoftheirabdomen,thepatientstopstheirinhalationduetopainfromthepressureontheirinflamedgallbladder.[1] Fivetotenpercentofacutecholecystitisoccursinpeoplewithoutgallstones,andforthisreason,iscalledacalculouscholecystitis.Itusuallydevelopsinpeoplewhohaveabnormalbiledrainagesecondarytoaseriousillness,suchaspeoplewithmulti-organfailure,serioustrauma,recentmajorsurgery,orfollowingalongstayintheintensivecareunit.[14] Peoplewithrepeatepisodesofacutecholecystitiscandevelopchroniccholecystitisfromchangesinthenormalanatomyofthegallbladder.[14]Thiscanalsobeanindicationforcholecystectomyifthepersonhasongoingpain.[citationneeded] Cholangitisandgallstonepancreatitis[edit] Cholangitisandgallstonepancreatitisarerarerandmoreseriouscomplicationsfromgallstonedisease.Bothcanoccurifgallstonesleavethegallbladder,passthroughthecysticduct,andgetstuckinthecommonbileduct.Thecommonbileductdrainstheliverandpancreas,andablockagetherecanleadtoinflammationandinfectioninboththepancreasandbiliarysystem.Whilecholecystectomyisnotusuallytheimmediatetreatmentchoiceforeitheroftheseconditions,itisoftenrecommendedtopreventrepeatepisodesfromadditionalgallstonesgettingstuck.[12]: 940, 1017  Gallbladdercancer[edit] Gallbladdercancer(alsocalledcarcinomaofthegallbladder)isarareindicationforcholecystectomy.Incaseswherecancerissuspected,theopentechniqueforcholecystectomyisusuallyperformed.[11] Livertransplantation[edit] Inlivingdonorlivertransplantationbetweenadults,acholecystectomyisperformedinthedonorbecausegallbladderinterfereswithremovaloftheright(lateral)lobeoftheliverandtopreventtheformationofgallstonesintherecipient.[15][16]Thegallbladderisnotremovedinpediatrictransplantationsastheleftlobeoftheliverisusedinstead.[17] Contraindications[edit] Therearenospecificcontraindicationsforcholecystectomy,andingeneralitisconsideredalow-risksurgery.However,anyonewhocannottoleratesurgeryundergeneralanesthesiashouldnotundergocholecystectomy.PeoplecanbesplitintohighandlowriskgroupsusingatoolsuchastheASAphysicalstatusclassificationsystem.Inthissystem,peoplewhoareASAcategoriesIII,IV,andVareconsideredhighriskforcholecystectomy.Typicallythisincludesveryelderlypeopleandpeoplewithco-existingillness,suchasend-stageliverdiseasewithportalhypertensionandwhoseblooddoesnotclotproperly.[6]Alternativestosurgeryarebrieflymentionedbelow. Risks[edit] Allsurgerycarriesriskofseriouscomplicationsincludingdamagetonearbystructures,bleeding,infection,[18]orevendeath.Theoperativedeathrateincholecystectomyisabout0.1%inpeopleunderage50andabout0.5%inpeopleoverage50.[8]Thegreatestriskofdeathcomesfromco-existingillnesslikecardiacorpulmonarydisease.[19] Biliaryinjury[edit] Aseriouscomplicationofcholecystectomyisbiliaryinjury,ordamagetothebileducts.[20]Laparoscopiccholecystectomyhasahigherriskofbileductinjurythantheopenapproach,withinjurytobileductsoccurringin0.3%to0.5%oflaparoscopiccasesand0.1%to0.2%ofopencases.[21]Inlaparoscopiccholecystectomy,approximately25–30%ofbiliaryinjuriesareidentifiedduringtheoperation;therestbecomeapparentintheearlypost-operativeperiod.[3][page needed] Damagetothebileductsisveryseriousbecauseitcausesleakageofbileintotheabdomen.Signsandsymptomsofabileleakincludeabdominalpain,tenderness,feverandsignsofsepsisseveraldaysfollowingsurgery,orthroughlaboratorystudiesasrisingtotalbilirubinandalkalinephosphatase.[20]Complicationsfromabileleakcanfollowapersonforyearsandcanleadtodeath.Bileleakshouldalwaysbeconsideredinanypatientwhoisnotrecoveringasexpectedaftercholecystectomy.[20]Mostbileinjuriesrequirerepairbyasurgeonwithspecialtraininginbiliaryreconstruction.Ifbiliaryinjuriesareproperlytreatedandrepaired,morethan90%ofpatientscanhavealong-termsuccessfulrecovery.[21] InjuryofthebileductscanbepreventedandtreatedbyroutinelyusingX-rayinvestigationofthebileducts(intraoperativecholangiography(IOC)).[22]ThismethodwasassessedbytheSwedishSBUandroutineusedeemedtodecreaseriskofinjuryandmorbidityfollowingunaddressedinjurywhileonlyincreasingcancerratesduetoradiationexposurebyalesserfraction.[22] Othercomplications[edit] Areviewofsafetydatainlaparoscopiccholecystectomyfoundthefollowingcomplicationstobemostcommon: Ratesofcomplicationsotherthanbileductinjuryafterlaparoscopiccholecystectomy[23] Complication Prevalence Woundinfection 1.25% Urinaryretention 0.90% Bleeding 0.79% Retainedstoneinthecommonbileduct 0.50% Respiratory 0.48% Cardiac 0.36% Intra-abdominalabscess 0.34% Hernia 0.21% Thesamestudyfoundtheprevalenceofbowelinjury,sepsis,pancreatitis,anddeepveinthrombosis/pulmonaryembolismtobearound0.15%each.[23] Leakagefromthestumpofthecysticductisacomplicationthatismorecommonwiththelaparoscopicapproachthantheopenapproachbutisstillrare,occurringinlessthan1%ofprocedures;itistreatedbydrainagefollowedbyinsertionofabileductstent.[24] Anothercomplicationsingulartothelaparoscopicprocedureisthephenomenonofthe"spilledgallstone"whichcomplicates0.08–0.3%ofcases.[25]Hereastoneescapestheresectedgallbladderintotheabdomenwhereitcanbecomeafocusforinfectionifitisnotidentifiedandremoved.[26]Somereportsexistofspilledstoneslyingunnoticedforupto20yearsbeforeeventuallycausinganabscesstoform.[27] Conversiontoopencholecystectomy[edit] Expertsagreethatmanybiliaryinjuriesinlaparoscopiccasesarecausedbydifficultiesseeingandidentifyingtheanatomyclearly.Ifthesurgeonhasproblemsidentifyinganatomicalstructures,theymightneedtoconvertfromlaparoscopictoopencholecystectomy.[28] PeroperativeEndoscopicRetrogradeCholangio-Pancreaticography(ERCP)/Laparo-endoscopicrendezvous(LERV)technique CBDSarefoundin10-15%ofpatientsduringcholecystectomywhenintraoperativecholangiography(IOC)isroutinelyperformed.[29][30]Thereareseveralstrategiestomanagecholedocholithiasisbuttheoptimalmethodaswellasthetimingoftreatmentisstillunderdebate.[31] InrecentyearstheLERVtechnique,inwhichaccesstothecommonbileductbyERCPisfacilitatedbyanantegradeguidewire,whichisintraoperativelyintroducedduringfluoroscopyandisadvancedthroughthecysticducttotheduodenum,hasbeenestablishedasanalternativetotreatcommonbileductstonesdiscoveredduringlaparoscopiccholecystectomy.Thistechniquewasfirstdescribedin1993byDeslandresetal.[32]andhas,inseveralstudies,beenshowntohaveahighrateofCBDstonesclearanceandareducednumberofcomplications,particularlypost-ERCPpancreatitis,incomparisonwithconventionalERCP.[33][34]ThisisprobablyduetothefacilitatedaccesstothecommonbileductwithalesserdegreeofmanipulationandtraumatothepapillaVateri.InastudybySwahnetal.therendezvousmethodwasshowntoreducetheriskofPEPfrom3.6to2.2%comparedwithconventionalbiliarycannulation.[35]Thesuccessrateofpassingthetranscysticguidewireintotheduodenumhasbeenreportedtobeover80%.[36] Procedure[edit] Abdomenofa45-year-oldmaleapproximatelyonemonthafteralaparoscopiccholecystectomy.Surgicalincisionpointsarehighlighted;theoneattoprightisbarelyvisible.Thegallbladderwasremovedviatheincisionatthenavel.Thereisafourthincision(notshown)ontheperson'srightlowerflank,usedfordraining.Allincisionshavehealedwellandthemostvisibleremainingeffectofsurgeryisfromthepre-operativehairremoval. Stepsofacholecystectomy,asseenthroughalaparoscope The1-week-oldincisionsofapost-operativelaparoscopiccholecystectomyasindicatedbyredarrows.The3abdominalincisionsareapproximately6mm,whilethefourthincisionneartheumbilicusis18mm,eachclosedwithdissolvablesutures.MinorinflammationcanbeseensurroundingeachsiteduetoskinirritationcausedbyremovalofTegadermdressings. Pre-operativepreparation[edit] Beforesurgery,acompletebloodcountandliverfunctiontestsareusuallyobtained.[37]Prophylactictreatmentisgiventopreventdeepveinthrombosis.[37]Useofprophylacticantibioticsiscontroversial;however,adosemaybegivenpriortosurgerytopreventinfectionincertainpeopleathighrisk.[38][39]GasmayberemovedfromthestomachwithanOGorNGtube.[37]AFoleycathetermaybeusedtoemptythepatient'sbladder.[37] Laparoscopiccholecystectomy[edit] Laparoscopiccholecystectomyusesseveral(usually4)smallincisionsintheabdomentoallowtheinsertionofoperatingports,smallcylindricaltubesapproximately5to10 mmindiameter,throughwhichsurgicalinstrumentsareplacedintotheabdominalcavity.Thelaparoscope,aninstrumentwithavideocameraandlightsourceattheend,illuminatestheabdominalcavityandsendsamagnifiedimagefrominsidetheabdomentoavideoscreen,givingthesurgeonaclearviewoftheorgansandtissues.Thecysticductandcysticarteryareidentifiedanddissected,thenligatedwithclipsandcutinordertoremovethegallbladder.Thegallbladderisthenremovedthroughoneoftheports.[40] Asof2008,90%ofcholecystectomiesintheUnitedStatesweredonelaparoscopically.[41]Laparoscopicsurgeryisthoughttohavefewercomplications,shorterhospitalstay,andquickerrecoverythanopencholecystectomy.[42] Singleincision[edit] Singleincisionlaparoscopicsurgery(SILS)orlaparoendoscopicsinglesitesurgery(LESS)isatechniqueinwhichasingleincisionismadethroughthenavel,insteadofthe3-4foursmalldifferentincisionsusedinstandardlaparoscopy.Thereappearstobeacosmeticbenefitoverconventionalfour-holelaparoscopiccholecystectomy,andnoadvantageinpostoperativepainandhospitalstaycomparedwithstandardlaparoscopicprocedures.[43]ThereisnoscientificconsensusregardingriskforbileductinjurywithSILSversustraditionallaparoscopiccholecystectomy.[43] Naturalorificetransluminal[edit] Naturalorificetransluminalendoscopicsurgery(NOTES)isanexperimentaltechniquewherethelaparoscopeisinsertedthroughnaturalorificesandinternalincisions,ratherthanskinincisions,toaccesstotheabdominalcavity.[44]Thisoffersthepotentialtoeliminatevisiblescars.[45]Since2007,cholecystectomybyNOTEShasbeenperformedanecdotallyviatransgastricandtransvaginalroutes.[44]Asof2009theriskofgastrointestinalleak,difficultyvisualizingtheabdominalcavityandothertechnicallimitationslimitedfurtheradoptionofNOTESforcholecystectomy.[45] Opencholecystectomy[edit] Inopencholecystectomy,asurgicalincisionofaround8to12 cmismadebelowtheedgeoftherightribcageandthegallbladderisremovedthroughthislargeopening,typicallyusingelectrocautery.[40]Opencholecystectomyisoftendoneifdifficultiesariseduringalaparoscopiccholecystecomy,forexample,thepatienthasunusualanatomy,thesurgeoncannotseewellenoughthroughthecamera,orthepatientisfoundtohavecancer.[40]Itcanalsobedoneifthepatienthasseverecholecystitis,emphysematousgallbladder,fistulizationofgallbladderandgallstoneileus,cholangitis,cirrhosisorportalhypertension,andblooddyscrasias.[40] Biopsy[edit] Afterremoval,thegallbladdershouldbesentforpathologicalexaminationtoconfirmthediagnosisandlookforanyincidentalcancer.Incidentalcancerofthegallbladderisfoundinapproximately1%ofcholecystectomies.[12]: 1019 Ifcancerispresentinthegallbladder,itisusuallynecessarytore-operatetoremovepartsoftheliverandlymphnodesandtestthemforadditionalcancer.[46] Post-operativemanagement[edit] Aftersurgery,mostpatientsareadmittedtothehospitalforroutinemonitoring.Foruncomplicatedlaparoscopiccholecystectomies,peoplemaybedischargedonthedayofsurgeryafteradequatecontrolofpainandnausea.[39]Patientswhowerehigh-risk,thosewhorequiredemergencysurgery,and/orthoseundergoingopencholecystectomyusuallyneedtostayinthehospitalseveraldaysaftersurgery.[19] Long-termprognosis[edit] In95%ofpeopleundergoingcholecystectomyastreatmentforsimplebiliarycolic,removingthegallbladdercompletelyresolvestheirsymptoms.[8] Upto10%ofpeoplewhoundergocholecystectomydevelopaconditioncalledpostcholecystectomysyndrome.[4]Symptomsaretypicallysimilartothepainanddiscomfortofbiliarycolicwithpersistentpainintheupperrightabdomenandcommonlyincludegastrointestinaldistress(dyspepsia).[4] Somepeoplefollowingcholecystectomymaydevelopdiarrhea.[6]Thecauseisunclear,butispresumedtobeduetodisturbancesinthebiliarysystemthatspeedupenterohepaticrecyclingofbilesalts.Theterminalileum,theportionoftheintestinewherethesesaltsarenormallyreabsorbed,becomesoverwhelmed,doesnotabsorbeverything,andthepersondevelopsdiarrhea.[6]Mostcasesresolvewithinweeksorafewmonths,thoughinrarecasestheconditioncanlastforyears.Itcanbecontrolledwithmedicationsuchascholestyramine.[medicalcitationneeded] Considerations[edit] Pregnancy[edit] Itisgenerallysafeforpregnantwomentoundergolaparoscopiccholecystectomyduringanytrimesterofpregnancy.[7]Earlyelectivesurgeryisrecommendedforwomenwithsymptomaticgallstonestodecreasetheriskofspontaneousabortionandpre-termdelivery.[7]Withoutcholecystectomy,morethanhalfofsuchwomenwillhaverecurrentsymptomsduringtheirpregnancy,andnearlyoneinfourwilldevelopacomplication,suchasacutecholecystitis,thatrequiresurgentsurgery.[7]Acutecholecystitisisthesecondmostcommoncauseofacuteabdomeninpregnantwomenafterappendectomy.[14] Porcelaingallbladder[edit] Porcelaingallbladder(PGB),aconditionwherethegallbladderwallshowscalcificationonimagingtests,waspreviouslyconsideredareasontoremovethegallbladderbecauseitwasthoughtthatpeoplewiththisconditionhadahighriskofdevelopinggallbladdercancer.[1]However,recentstudieshaveshownthatthereisnostrongassociationbetweengallbladdercancerandporcelaingallbladder,andthatPGBaloneisnotastrongenoughindicationforaprophylacticcholecystectomy.[7] Alternativestosurgery[edit] Thereareseveralalternativestocholecystectomyforpeoplewhodonotwantsurgery,orinwhomthebenefitsofsurgerywouldnotoutweightherisks. Conservativemanagement[edit] Conservativemanagementforbiliarycolicinvolvesa"watchandwait"approach—treatingsymptomsas-neededwithoralmedications.Expertsagreethatthisisthepreferredtreatmentforpeoplewithgallstonesbutnosymptoms.[7]Conservativemanagementmayalsobeappropriateforpeoplewithmildbiliarycolic,asthepainfromcoliccanbemanagedwithpainmedicationslikeNSAIDs(ex:ketorolac)oropioids.[1] Conservativemanagementforacutecholecystitisinvolvestreatingtheinfectionwithoutsurgery.Itisusuallyonlyconsideredinpatientsatveryhighriskforsurgeryorotherinterventionslistedbelow.Itconsistsoftreatmentwithintravenousantibioticsandfluids.[47] ERCP[edit] InERCP,theendoscopeentersthroughthemouthandpassesthroughthestomachandstartofthesmallintestinetoreachthebileducts. Thisisacholangiogram,anx-rayofthebileductsusingcontrastmediumtomakethebileductsvisible.1–Duodenum.2–Commonbileduct.3–Cysticduct.4–Hepaticduct.Thegallbladderisnotseenasthecysticductisoccludedbyasurgicalinstrument. ERCP,shortforendoscopicretrogradecholangiopancreatography,isanendoscopicprocedurethatcanremovegallstonesorpreventblockagesbywideningpartsofthebileductwheregallstonesfrequentlygetstuck.ERCPisoftenusedtoretrievestonesstuckinthecommonbileductinpatientswithgallstonepancreatitisorcholangitis.Inthisprocedure,anendoscope,orsmall,longthintubewithacameraontheend,ispassedthroughthemouthanddowntheesophagus.Thedoctoradvancesthecamerathroughthestomachandintothefirstpartofthesmallintestinetoreachtheopeningofthebileduct.Thedoctorcaninjectaspecial,radiopaquedyethroughtheendoscopeintothebileducttoseestonesorotherblockagesonx-ray.[48]ERCPdoesnotrequiregeneralanaesthesiaandcanbedoneoutsideoftheoperatingroom.WhileERCPcanbeusedtoremoveaspecificstonethatiscausingablockagetoallowdrainage,itcannotremoveallstonesinthegallbladder.Thus,itisnotconsideredadefinitivetreatmentandpeoplewithrecurrentcomplicationsfromstoneswillstilllikelyneedacholecystectomy.[citationneeded] Cholecystostomy[edit] Cholecystostomyisthedrainageofthegallbladderviainsertionofasmalltubethroughtheabdominalwall.Thisisusuallydoneusingguidancefromimagingscanstofindtherightplacetoinsertthetube.Cholecystostomycanbeusedforpeoplewhoneedimmediatedrainageofthegallbladderbuthaveahighriskofcomplicationsfromsurgeryundergeneralanaesthesia,suchaselderlypeopleandthosewithco-existingillnesses.[47]Drainingpusandinfectedmaterialthroughthetubereducesinflammationinandaroundthegallbladder.Itcanbealifesavingprocedure,withoutrequiringthatthepersonundergoemergencysurgery.[49] Theproceduredoescomewithsignificantrisksandcomplications—inoneretrospectivestudyofpatientswhoreceivedpercutaneouscholecystostomyforacutecholecystitis,44%developedcholedocholithiasis(oneormorestonesstuckinthecommonbileduct),27%hadtubedislodgment,and23%developedpostoperativeabscess.[49] Forsomepeople,drainagewithcholecystostomyisenoughandtheydonotneedtohavethegallbladderremovedlater.Forothers,percutaneouscholecystostomyallowsthemtoimproveenoughintheshorttermthattheycangetsurgeryatalatertime.[47]Thereisnoclearevidenceonewayoranothertoindicatethatsurgicalremovalaftercholecystostomyisbestforhigh-risksurgicalpatientswithacutecholecystitis.[47] Frequencyofuse[edit] About600,000peoplereceiveacholecystectomyintheUnitedStateseachyear.[12]: 855  InastudyofMedicaid-coveredanduninsuredU.S.hospitalstaysin2012,cholecystectomywasthemostcommonoperatingroomprocedure.[50] History[edit] CarlLangenbuchperformedthefirstsuccessfulcholecystectomyin1882. CarlLangenbuchperformedthefirstsuccessfulcholecystectomyattheLazarushospitalinBerlinonJuly15,1882.[51]Beforethis,surgicaltherapyforsymptomaticgallstoneswaslimitedtocholecystostomy,orgallstoneremoval.[51]Langenbuch'srationalefordevelopingthenewtechniquestemmedfrom17thcenturystudiesindogsthatdemonstratedthegallbladdertobenonessentialandmedicalopinionamonghiscolleaguesthatgallstonesformedinthegallbladder.[51]Althoughthetechniquewasinitiallycontroversial,cholecystectomybecameestablishedasalowermortalityprocedurethancholecystostomybythe20thcentury.[51] Laparoscopictechnique[edit] ErichMüheperformedthefirstlaparoscopiccholecystectomyonSeptember12,1985,inBöblingen,Germany.[52]Mühewasinspiredtodevelopatechniqueforlaparoscopiccholecystectomybythefirstlaparoscopicappendectomy,performedbygynecologistKurtSemmin1980.[53]Hesubsequentlydesignedanopticallaparoscopewithaworkingchannellargeenoughtofitadistendedgallbladder.[53]MühepresentedhistechniquetotheCongressoftheGermanSurgicalSocietyin1986,claimingreducedpostoperativepainandshorterhospitalization.[54]HisworkwasmetwithstrongresistancebytheGermansurgicalestablishmentandhehaddifficultycommunicatingitinEnglish.Itwasconsequentlyignored.[53]Mühe'sworkwasfurtherdisparagedin1987,whenhewaschargedwithmanslaughterforapostoperativepatientdeaththatwasmistakenlyattributedtohisinnovativetechnique.[55]Hewasexoneratedin1990afterfurtherinvestigation.[55]HispioneeringworkwaseventuallyrecognizedbytheGermanSurgicalSocietyCongressin1992.[53] PhilippeMouretperformedlaparoscopiccholecystectomyonMarch17,1987,inLyon,France.[53]HistechniquewasrapidlyadoptedandimprovedinFrance.[53]Itwassubsequentlyintroducedtotherestoftheworldoverthenextthreeyears.[53]Drivenbypopularityamongpatients,thelaparoscopictechniquebecamepreferredoveropensurgeryandnoninvasivetreatmentsforgallstones.[53] By2013,laparoscopiccholecystectomyhadreplacedopencholecystectomyasthefirst-choiceoftreatmentforpeoplewithuncomplicatedgallstonesandacutecholecystitis.[40][56] By2014laparoscopiccholecystectomyhadbecomethegoldstandardforthetreatmentofsymptomaticgallstones.[37][57] Laparoscopiccholecystectomycanbeachallengingprocedureandsurgeonsmustbetrainedwithadvancedlaparoscopicskillstocompletetheoperationwithsafetyandeffectiveness.[58] Seealso[edit] Listofsurgeriesbytype Listof-ectomies WaltmanWaltersyndrome References[edit] ^abcdefAbrahamS,RiveroHG,ErlikhIV,GriffithLF,KondamudiVK(May2014)."Surgicalandnonsurgicalmanagementofgallstones".AmericanFamilyPhysician.89(10):795–802.PMID 24866215. ^"CharacteristicsofOperatingRoomProceduresinU.S.Hospitals,2011–StatisticalBrief#170".www.hcup-us.ahrq.gov.Retrieved2018-01-24. ^abMulhollandMW,LillemoeKD,DohertyGM,UpchurchGR,AlamHB,PawlikTM(December2016).Greenfield'ssurgery :scientificprinciples&practice(Sixth ed.).Philadelphia.ISBN 978-1-4698-9001-2.OCLC 933274207. ^abcdJaunooSS,MohandasS,AlmondLM(2010)."Postcholecystectomysyndrome(PCS)".InternationalJournalofSurgery.8(1):15–7.doi:10.1016/j.ijsu.2009.10.008.PMID 19857610. ^"TheNationalInstitutesofHealth(NIH)ConsensusDevelopmentProgram:GallstonesandLaparoscopicCholecystectomy".consensus.nih.gov.Retrieved2018-03-20. ^abcdTownsendCM,EversBM,MattoxKL,BeauchampRD(June2016).Sabistontextbookofsurgery :thebiologicalbasisofmodernsurgicalpractice(20th ed.).Philadelphia,PA.ISBN 978-0-323-29987-9.OCLC 951748294. 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Furtherreading[edit] "OperationBrochuresforPatients:Cholecystectomy".AmericanCollegeofSurgeons. "Gallbladderremoval".NHS.23October2017.Retrieved4January2020. vteTestsandproceduresinvolvingthedigestivesystemDigestivesystemsurgeryDigestivetractUpperGItractSGs/Esophagus Esophagectomy Hellermyotomy Sialography Impedance–pHmonitoring EsophagealpHmonitoring Esophagealmotilitystudy FunctionalLumenImagingProbe Highresolutionmanometry Stomach Sengstaken–Blakemoretube) Nasogastrictube Gastriclavage Bariatricsurgery Adjustablegastricband Endoscopicsleevegastroplasty Gastricbypasssurgery Sleevegastrectomy Verticalbandedgastroplastysurgery Collisgastroplasty Gastrectomy BillrothI BillrothII Roux-en-Y Gastroenterostomy Gastropexy Gastrostomy Percutaneousendoscopicgastrostomy Esophagogastricdissociation Hillrepair Nissenfundoplication Pyloromyotomy Schillingtest Medicalimaging Endoscopy Esophagogastroduodenoscopy Bariumswallow Uppergastrointestinalseries LowerGItractSmallbowel Bariatricsurgery Duodenalswitch Jejunoilealbypass Bowelresection Ileostomy Intestinetransplantation Jejunostomy Partialilealbypasssurgery Strictureplasty Largebowel Appendectomy Colectomy Colonicpolypectomy Colostomy Hartmann'soperation Rectum Abdominoperinealresection Loweranteriorresection Totalmesorectalexcision Analcanal Analsphincterotomy Anorectalmanometry Lateralinternalsphincterotomy Rubberbandligation Transanalhemorrhoidaldearterialization Medicalimaging Endoscopy:Colonoscopy Anoscopy Capsuleendoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominalultrasonography Defecography Double-contrastbariumenema Endoanalultrasound Enteroclysis Lowergastrointestinalseries Small-bowelfollow-through Transrectalultrasonography Virtualcolonoscopy Stooltests Fecalfattest FecalpHtest Stoolguaiactest AccessoryLiver Artificialextracorporealliversupport Bioartificialliverdevices Liverdialysis Hepatectomy Liverbiopsy Livertransplantation Portalhypertension Transjugularintrahepaticportosystemicshunt[TIPS] Distalsplenorenalshuntprocedure Gallbladder,bileduct Cholecystectomy Cholecystostomy ERCP Hepatoportoenterostomy Medicalimaging:Cholangiography IV MRCP PTC Cholecystography Cholescintigraphy Pancreas Frey'sprocedure Pancreastransplantation Pancreatectomy Pancreaticoduodenectomy Puestowprocedure AbdominopelvicPeritoneum Diagnosticperitoneallavage Intraperitonealinjection Laparoscopy Omentopexy Paracentesis Peritonealdialysis Hernia Herniarepair Inguinalherniasurgery Femoralherniarepair Other Laparotomy Exploratorylaparotomy Rapidureasetest/Ureabreathtest Clinicalpredictionrules MELD PELD UKELD Child–Pughscore Ransoncriteria Milancriteria Retrievedfrom"https://en.wikipedia.org/w/index.php?title=Cholecystectomy&oldid=1095355432" Categories:AccessorydigestiveglandsurgerySurgicalremovalproceduresHiddencategories:CS1errors:missingperiodicalAllarticleswithdeadexternallinksArticleswithdeadexternallinksfromJune2022ArticleswithshortdescriptionShortdescriptionmatchesWikidataWikipediaarticlesneedingpagenumbercitationsfromFebruary2018AllarticleswithunsourcedstatementsArticleswithunsourcedstatementsfromJanuary2022ArticleswithunsourcedstatementsfromMarch2018 Navigationmenu Personaltools NotloggedinTalkContributionsCreateaccountLogin Namespaces ArticleTalk English Views ReadEditViewhistory More Search Navigation MainpageContentsCurrenteventsRandomarticleAboutWikipediaContactusDonate Contribute HelpLearntoeditCommunityportalRecentchangesUploadfile Tools WhatlinkshereRelatedchangesUploadfileSpecialpagesPermanentlinkPageinformationCitethispageWikidataitem Print/export DownloadasPDFPrintableversion Inotherprojects WikimediaCommons Languages العربيةAzərbaycancaBosanskiČeštinaDeutschދިވެހިބަސްΕλληνικάEspañolEsperantoفارسیFrançaisGalegoՀայերենहिन्दीHrvatskiBahasaIndonesiaItalianoעבריתNederlands日本語PolskiPortuguêsРусскийСрпски/srpskiSrpskohrvatski/српскохрватскиSvenskaதமிழ்TürkçeУкраїнська Editlinks