Laparoscopic Cholecystectomy

Excerpt

Laparoscopic cholecystectomy is a minimally invasive surgical technique used to remove a diseased gallbladder. Since the early 1990s, this procedure has largely supplanted the open approach for routine cholecystectomies due to its safety profile and faster recovery times. Indications for laparoscopic cholecystectomy include acute and chronic cholecystitis, symptomatic cholelithiasis, biliary dyskinesia (either hypo- or hyperfunctional), acalculous cholecystitis, gallstone pancreatitis, and gallbladder polyps or masses. These are the same conditions traditionally treated with open cholecystectomy. The laparoscopic approach remains the preferred modality for most cases due to its lower morbidity; however, bile duct injury remains a key complication, with rates that have not significantly declined over the past 30 years, despite advances in visualization and surgical technique.

In cases involving known or suspected gallbladder carcinoma, an open cholecystectomy remains the standard approach. In the United States, an estimated 20 million people have gallstones, and about 300,000 cholecystectomies are performed each year. Among those with gallstones, roughly 10% to 15% are asymptomatic, but of those, 20% develop symptoms. Of the symptomatic population, around 1% to 4% develop complications, such as acute cholecystitis, pancreatitis, choledocholithiasis, or gallstone ileus. Gallstone prevalence increases with age and is more common in women than men. Among individuals aged 50 to 65, approximately 20% of women and 5% of men have gallstones. Roughly 75% of gallstones are cholesterol-based, with the remainder consisting of pigmented stones—yet clinical manifestations are similar across stone types.