Medical Health Encyclopedia Patients with complications of acute cholecystitis (empyema, gangrene, perforation of the gallbladder).
Patients with acalculous gallbladder disease (without stones) who choose to have surgery. (The procedure of choice if such patients have inflammation, however, is percutaneous cholecystostomy--a procedure that drains the gallbladder.)	Very elderly patients. (Those over 80 are likely to have lower complication rates from open cholecystectomy than laparoscopy, although laparoscopy may even be appropriate in these patients.)
Text Continues Below Patients with residual gallbladder stones after endoscopic sphincterotomy for common bile duct stones.
Candidates when experienced surgeons are available: Patients with acute gallstone pancreatitis that has subsided. Severely obese patients Patients with prior surgery in the upper abdomen. Patients with severely infected gallbladders. Pregnant women with symptomatic gallstones.	Seriously ill patients with acute cholecystitis who do not respond to fluid aspiration (percutaneous cholecystostomy).

Laparoscopic Cholecystectomy

The Procedure. With laparoscopy, removal of the gallbladder is typically performed as follows:

Laparoscopic cholecystectomy requires general anesthesia, although it is now mostly done as outpatient surgery.

• The surgeon inserts a needle through the navel and pumps carbon dioxide gas through it and into the abdomen to create space in the abdomen. (This step may raise blood pressure. The antihypertensive drug clonidine may be helpful during surgery to protect patients with high blood pressure or heart or kidney disease. Of note, a 2000 study recommended that elderly patients not receive gas. Such patients are more likely to require a longer operating time, and the on-going pressure from the carbon dioxide increases the risk for problems that require conversion to an open procedure.)
• Small incisions, one or two 10 to 12 mm (around half an inch) and three 5 mm (.20 inches), are made in the abdomen.
• The surgeon inserts a laparoscope (a thin telescope) which contains a small surgical instrument and a tiny camera that relays an image to a video monitor.
• The surgeon separates the gallbladder from the liver and other areas and removes it through one of the incisions.
• Evidence suggests that the use of cholangiography during the operation helps prevent injury in the bile ducts, a serious complication of cholecystectomy. (Cholangiography may also used be in laparoscopy.) With this procedure, a dye is injected into the bile duct and x-rays are used to view the duct.
• In general, 24-hour monitoring afterward is not necessary and the patient can go home the same day. It should be noted, however, that according to a 2001 study some patients may be at higher risk for readmission later on, including those who required more than an hour for the operation or who had thicker gallbladder walls