Cholecystectomy

Cholecystectomy is the surgical removal of the gallbladder. It is performed to treat gallstone disease and other gallbladder conditions, most commonly symptomatic cholelithiasis and acute or chronic cholecystitis. It may also be used for gallbladder polyps or biliary dyskinesia.

Most cholecystectomies are performed laparoscopically, using several small incisions and a camera. The patient is under general anesthesia. The gallbladder is separated from the liver bed, and the cystic duct and cystic artery are clipped and divided before the gallbladder is removed. If the anatomy is unclear or complications arise, conversion to an open cholecystectomy may be necessary.

Open cholecystectomy is still performed for certain patients, such as those with scarring, severe inflammation, or previous abdominal surgery, where laparoscopy is not feasible.

Postoperative course: laparoscopic cholecystectomy typically allows discharge within 1-2 days and a return to normal activities within 1-2 weeks. Open surgery has a longer recovery. Possible complications include injury to the bile ducts or other biliary structures, bile leakage, bleeding, infection, and hernia at incision sites. Most patients have good long-term outcomes and no recurrence of gallbladder-related pain.

Alternatives: nonoperative management for asymptomatic stones; ursodeoxycholic acid to dissolve certain small cholesterol stones in selected patients; endoscopic or percutaneous approaches for drainage in complicated cases. The choice of procedure depends on symptoms, stone burden, anatomy, and patient factors.