Medical Health Encyclopedia

Some experts believe, however, that the open procedure still has a number of advantages compared to laparoscopy:

• It is faster to perform.
• It poses less of a risk for bile duct injury, which occurs in only 0.1% to 0.5% of open procedures, compared to about 0.3% to more than 2% with laparoscopy. (It has more overall complications than laparoscopy, however, and laparoscopy bile-duct injury rates are declining.)

The type of surgery performed on specific patients may vary depending on different factors.

Appropriate Surgical Candidates. Candidates for gallbladder removal often have one of the following conditions:

• After a very severe gallstone attack.
• After several less severe gallstone attacks.
• After endoscopic sphincterotomy for common bile duct stones in patients with residual gallbladder stones.
• In patients with cholecystitis (gallbladder inflammation).
• In patients with pancreatitis (inflammation of the pancreas).
• In patients at risk for gallbladder cancer (e.g., patients with anomalous junction of the pancreatic and biliary ducts or patients with certain forms of porcelain gallbladder).
• In some patients with acalculous biliary pain (gallbladder disease symptoms without the presence of gallstones). Best candidates are those with evidence of impaired gallbladder emptying.

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Timing of Surgery. Cholecystectomy may be performed within several days to weeks after hospitalization for an acute gallbladder attack, depending on the severity of the condition.

• Emergency gallbladder removal within 24 to 48 hours is warranted in about 20% of patients with acute cholecystitis. Indications for surgery include deterioration of the patient's condition or signs of perforation or widespread infection.
• The timing and type of surgery in patients with acute cholecystitis whose condition improves and have no signs of severe complications are under debate. Previously, the standard was open cholecystectomy between six and 12 weeks after the acute episode. Some evidence now suggests that early surgery performed between 72 and 96 hours after symptoms have lower complications than surgery performed after that.