View source for Cholecystectomy

{{short description|Surgical removal of the gallbladder}}
{{Infobox medical intervention
|  Name        = Cholecystectomy
| pronounce    = {{IPAc-en|ˌ|k|ɒ|l|ə|s|ɪ|s|ˈ|t|ɛ|k|t|ə|m|i}}
|image =US Navy 081117-N-7526R-568 Cmdr. Thomas Nelson and Lt. Robert Roadfuss discuss proper procedures while performing a laparoscopic cholecystectomy surgery.jpg
| specialty    = [[General surgery]]
|  Caption     = A US Navy general surgeon and an operating room nurse performing a laparoscopic cholecystectomy
|  ICD10       =
|  ICD9        = {{ICD9proc|575.0}}
|  MeshID      = D002763
|  CPT         = 47562
}}

'''Cholecystectomy''' is the surgical removal of the [[gallbladder]]. Cholecystectomy is a common treatment of symptomatic [[gallstone]]s and other gallbladder conditions.<ref name="AFP2014" /> In 2011, cholecystectomy was the eighth most common operating room procedure performed in hospitals in the United States.<ref>{{Cite web|url=https://www.hcup-us.ahrq.gov/reports/statbriefs/sb170-Operating-Room-Procedures-United-States-2011.jsp|title=Characteristics of Operating Room Procedures in U.S. Hospitals, 2011 – Statistical Brief #170|website=www.hcup-us.ahrq.gov|access-date=2018-01-24}}</ref> Cholecystectomy can be performed either [[Laparoscopy|laparoscopically]] or through a [[laparotomy]].<ref name=Greenfields>{{Cite book|title=Greenfield's surgery: scientific principles & practice | first1 = Michael W | last1 = Mulholland | first2 = Keith D | last2 = Lillemoe | first3 = Gerard M | last3 = Doherty | first4 = Gilbert R | last4 = Upchurch | first5 = Hasan B | last5 = Alam | first6 = Timothy M | last6 = Pawlik | name-list-style = vanc  | isbn = 978-1-4698-9001-2 | edition = 6th |publisher=Wolters Kluwer | location = Philadelphia | oclc = 933274207 | date = December 2016 }}</ref>{{page needed|date=February 2018}}

The surgery is usually successful in relieving symptoms, but up to 10 percent of people may continue to experience similar symptoms after cholecystectomy, a condition called [[postcholecystectomy syndrome]].<ref name=Jaunoo2010/> Complications of cholecystectomy include [[Biliary injury|bile duct injury]], wound infection, bleeding, vasculobiliary injury, retained gallstones, liver [[abscess]] formation and [[stenosis]] (narrowing) of the bile duct.<ref>{{cite journal |last1=Jadrijevic |first1=S |last2=Sef |first2=D |last3=Kocman |first3=B |last4=Mrzljak |first4=A |last5=Matasic |first5=H |last6=Skegro |first6=D |title=Right hepatectomy due to portal vein thrombosis in vasculobiliary injury following laparoscopic cholecystectomy: a case report. |journal=Journal of Medical Case Reports |date=7 December 2014 |volume=8 |page=412 |doi=10.1186/1752-1947-8-412 |doi-access=free |pmid=25481385|pmc=4295332 }}</ref><ref name=Jaunoo2010/>
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==Medical use==
[[File:2425 Gallbladder.jpg|thumb|upright=1.3|Gallbladder anatomy]]
Pain and complications caused by [[gallstones]] are the most common reasons for removal of the gallbladder.<ref>{{Cite web|url=https://consensus.nih.gov/1992/1992GallstonesLaparoscopy090html.htm|title=The National Institutes of Health (NIH) Consensus Development Program: Gallstones and Laparoscopic Cholecystectomy|website=consensus.nih.gov|access-date=2018-03-20|archive-date=2018-03-20|archive-url=https://web.archive.org/web/20180320230801/https://consensus.nih.gov/1992/1992GallstonesLaparoscopy090html.htm}}</ref> The gallbladder can also be removed in order to treat [[biliary dyskinesia]] or [[gallbladder cancer]].<ref name="Sabiston20th" />

Gallstones are very common, but 50–80% of people with gallstones are asymptomatic and do not need surgery; their stones are noticed incidentally on imaging tests of the abdomen (such as [[Medical ultrasound|ultrasound]] or [[CT scan|CT]]) done for some other reason.<ref name="Consensus2015">{{cite journal | vauthors = Agresta F, Campanile FC, Vettoretto N, Silecchia G, Bergamini C, Maida P, Lombari P, Narilli P, Marchi D, Carrara A, Esposito MG, Fiume S, Miranda G, Barlera S, Davoli M | title = Laparoscopic cholecystectomy: consensus conference-based guidelines | journal = Langenbeck's Archives of Surgery | volume = 400 | issue = 4 | pages = 429–53 | date = May 2015 | pmid = 25850631 | doi = 10.1007/s00423-015-1300-4 | s2cid = 19853338 }}</ref> The traditional risk factors for gallstones are the four "F's: female, fat, forty, and fertile.<ref>{{cite journal |last1=Pak |first1=M |last2=Lindseth |first2=G |title=Risk Factors for Cholelithiasis. |journal=Gastroenterology Nursing|date=July 2016 |volume=39 |issue=4 |pages=297–309 |doi=10.1097/SGA.0000000000000235 |pmid=27467059|pmc=8802735 }}</ref> Of the more than 20 million people in the US with gallstones, only about 30% will eventually require cholecystectomy to relieve symptoms (pain) or treat complications.<ref name="CurrentSurg2015">{{Cite book|chapter-url=http://accessmedicine.mhmedical.com/content.aspx?aid=1105489553|title=CURRENT Diagnosis & Treatment: Surgery|last=Doherty|first=Gerard M.|date=2015|publisher=McGraw-Hill Education|editor-last=Doherty|editor-first=Gerard M. | name-list-style = vanc |edition= 14th |chapter=Biliary Tract |isbn=978-0-07-179211-0 |oclc=1328625901}}</ref>

===Biliary colic===
[[Biliary colic]], or pain caused by [[gallstone]]s, occurs when a gallstone temporarily blocks the bile duct that drains the gallbladder.<ref name=NIH2013>{{cite web|title=Gallstones|url=https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/gallstones/Pages/facts.aspx|website=NIDDK|access-date=27 July 2016|date=November 2013|archive-url=https://web.archive.org/web/20160728005016/https://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/gallstones/Pages/facts.aspx|archive-date=28 July 2016}}</ref> Typically, pain from biliary colic is felt in the right upper part of the [[abdomen]], is moderate to severe, and goes away on its own after a few hours when the stone is either passed or dislodges.<ref name=NICE2014>{{cite book | title = Gallstone Disease: Diagnosis and Management of Cholelithiasis, Cholecystitis and Choledocholithiasis. Clinical Guideline 188 | date = October 2014 | pmid = 25473723 |id=NBK258747  | author1 = Internal Clinical Guidelines Team (UK) |publisher=National Institute for Health and Care Excellence (NICE)}}</ref> Biliary colic usually occurs after meals when the gallbladder contracts to push bile out into the digestive tract. After a first attack of biliary colic, more than 90% of people will have a repeat attack in the next 10 years.<ref name=AFP2014>{{cite journal | vauthors = Abraham S, Rivero HG, Erlikh IV, Griffith LF, Kondamudi VK | title = Surgical and nonsurgical management of gallstones | journal = American Family Physician | volume = 89 | issue = 10 | pages = 795–802 | date = May 2014 | pmid = 24866215 | url = https://www.aafp.org/afp/2014/0515/p795.html }}</ref> Repeated attacks of biliary colic are the most common reason for removing the gallbladder, and lead to about 300,000 cholecystectomies in the US each year.<ref name="CurrentSurg2015" /><ref name=EssentialSurg2015>{{Cite book|title=Essential surgical procedures | last = Velasco | first = Jose M. | name-list-style = vanc | isbn = 978-0-323-37567-2 |publisher=Elsevier | location = Philadelphia, PA | oclc = 949278311 | date = October 2015 }}</ref>

=== Acute cholecystitis ===
[[Cholecystitis]], or [[inflammation]] of the gallbladder caused by interruption in the normal flow of bile, is another reason for cholecystectomy.<ref name="Goldman2011">{{cite book | title = Goldman's Cecil Medicine | last1 = Goldman | first1 = Lee | name-list-style = vanc | publisher = Elsevier Saunders | year = 2011 | isbn = 978-1-4377-2788-3 | edition = 24th | location = Philadelphia }}</ref>  It is the most common complication of gallstones; 90–95% of acute cholecystitis is caused by gallstones blocking drainage of the gallbladder.<ref>{{cite journal | vauthors = Kimura Y, Takada T, Strasberg SM, Pitt HA, Gouma DJ, Garden OJ, Büchler MW, Windsor JA, Mayumi T, Yoshida M, Miura F, Higuchi R, Gabata T, Hata J, Gomi H, Dervenis C, Lau WY, Belli G, Kim MH, Hilvano SC, Yamashita Y | title = TG13 current terminology, etiology, and epidemiology of acute cholangitis and cholecystitis | journal = Journal of Hepato-Biliary-Pancreatic Sciences | volume = 20 | issue = 1 | pages = 8–23 | date = January 2013 | pmid = 23307004 | doi = 10.1007/s00534-012-0564-0 | doi-access = free | hdl = 2292/22434 | hdl-access = free }}</ref> If the blockage is incomplete and the stone passes quickly, the person experiences biliary colic. If the gallbladder is completely blocked and remains so for a prolonged period, the person develops acute cholecystitis.<ref name=Tokyo2007>{{cite journal | vauthors = Kimura Y, Takada T, Kawarada Y, Nimura Y, Hirata K, Sekimoto M, Yoshida M, Mayumi T, Wada K, Miura F, Yasuda H, Yamashita Y, Nagino M, Hirota M, Tanaka A, Tsuyuguchi T, Strasberg SM, Gadacz TR | title = Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines | journal = Journal of Hepato-Biliary-Pancreatic Surgery | volume = 14 | issue = 1 | pages = 15–26 | date = 2007 | pmid = 17252293 | pmc = 2784509 | doi = 10.1007/s00534-006-1152-y }}</ref>

Pain in cholecystitis is similar to that of biliary colic, but lasts longer than six hours and occurs together with signs of [[infection]] such as [[fever]], [[chills]], or an [[Leukocytosis|elevated white blood cell count]].<ref name="AFP2014" /> People with cholecystitis will also usually have a positive [[Murphy's sign|Murphy sign]] on physical exam – meaning that when a doctor asks the patient to take a deep breath and then pushes down on the upper right side of their abdomen, the patient stops their inhalation due to pain from the pressure on their inflamed gallbladder.<ref name="AFP2014" />

Five to ten percent of acute cholecystitis occurs in people without gallstones, and for this reason, is called ''acalculous'' cholecystitis. It usually develops in people who have abnormal bile drainage secondary to a serious illness, such as people with multi-organ failure, serious trauma, recent major surgery, or following a long stay in the intensive care unit.<ref name=Tokyo2007/>

People with repeat episodes of acute cholecystitis can develop chronic cholecystitis from changes in the normal anatomy of the gallbladder.<ref name=Tokyo2007/> This can also be an indication for cholecystectomy if the person has ongoing pain.{{citation needed|date=January 2022}}

=== Cholangitis and gallstone pancreatitis ===
[[Ascending cholangitis|Cholangitis]] and [[Pancreatitis|gallstone pancreatitis]] are rarer and more serious complications from gallstone disease. Both can occur if gallstones leave the gallbladder, pass through the [[cystic duct]], and get stuck in the [[common bile duct]]. The common bile duct drains the liver and pancreas, and a blockage there can lead to inflammation and infection in both the pancreas and biliary system. While cholecystectomy is not usually the immediate treatment choice for either of these conditions, it is often recommended to prevent repeat episodes from additional gallstones getting stuck.<ref name="Goldman2011" />{{rp|940,1017}}

===Gallbladder cancer===
[[Gallbladder cancer]] (also called carcinoma of the gallbladder) is a rare indication for cholecystectomy. In cases where cancer is suspected, the open technique for cholecystectomy is usually performed.<ref name=EssentialSurg2015/>

===Liver transplantation===
In [[living donor liver transplantation]] between adults, a cholecystectomy is performed in the donor because the gallbladder interferes with removal of the right (lateral) lobe of the liver and to prevent the formation of gallstones in the recipient.<ref>{{Cite web|url=https://www.nebraskamed.com/transplant/liver/after-operation|title=What to expect after your liver transplant &#124; Nebraska Medicine Omaha, NE|website=www.nebraskamed.com}}</ref><ref>{{Cite web|url=https://www.umms.org/ummc/health-services/transplant/liver/living-donor|title=Living Donor Liver Transplant &#124; Baltimore|website=www.umms.org}}</ref> The gallbladder is not removed in [[pediatric]] transplantations as the left lobe of the liver is used instead.<ref>{{Cite web|url=https://www.ucsfbenioffchildrens.org/Education/Liver%20Donors%20FAQ%20The%20Donation%20Surgery|title=Liver Donors FAQ: The Donation Surgery|website=ucsfbenioffchildrens.org}}</ref>

==Contraindications==
There are no specific contraindications for cholecystectomy, and in general it is considered a low-risk surgery. However, anyone who cannot tolerate surgery under general anesthesia should not undergo cholecystectomy. People can be split into high and low risk groups using a tool such as the [[ASA physical status classification system]]. In this system, people who are ASA categories III, IV, and V are considered high risk for cholecystectomy. Typically this includes very elderly people and people with co-existing illness, such as end-stage liver disease with [[portal hypertension]] and [[coagulopathy|whose blood does not clot properly]].<ref name="Sabiston20th">{{Cite book|title=Sabiston textbook of surgery: the biological basis of modern surgical practice | first1 = Courtney M | last1 = Townsend | first2 = B Mark | last2 = Evers | first3 = Kenneth L | last3 = Mattox | first4 = R Daniel | last4 = Beauchamp | name-list-style = vanc | isbn = 978-0-323-29987-9 | edition = 20th | date = June 2016 |publisher=Elsevier Saunders | location = Philadelphia, PA | oclc = 951748294}}</ref> Alternatives to surgery are briefly mentioned below.

==Risks==
All surgery carries risk of serious complications including damage to nearby structures, bleeding, infection,<ref>{{cite web|title=Cholecystectomy
|date=19 November 2019 |publisher=Johns Hopkins Medical|url=https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/cholecystectomy}}</ref> or even death. The operative death rate in cholecystectomy is about 0.1% in people under age 50 and about 0.5% in people over age 50.<ref name="CurrentSurg2015"/> The greatest risk of death comes from co-existing illness like cardiac or pulmonary disease.<ref name="SSAT">{{cite web | url = http://ssat.com/guidelines/Gallstone-and-Gallbladder-Disease.cgi|title=Treatment of Gallstones and Gallbladder Disease | website =Society for Surgery of the Alimentary Tract|access-date=2018-03-27}}{{dead link|date=June 2022}}</ref>

=== Biliary injury ===
A serious complication of cholecystectomy is [[biliary injury]], or damage to the bile ducts.<ref name="Abbasoğlu_2016">{{cite journal | vauthors = Abbasoğlu O, Tekant Y, Alper A, Aydın Ü, Balık A, Bostancı B, Coker A, Doğanay M, Gündoğdu H, Hamaloğlu E, Kapan M, Karademir S, Karayalçın K, Kılıçturgay S, Şare M, Tümer AR, Yağcı G | title = Prevention and acute management of biliary injuries during laparoscopic cholecystectomy: Expert consensus statement | journal = Ulusal Cerrahi Dergisi | volume = 32 | issue = 4 | pages = 300–5 | date = 2016 | pmid = 28149133 | pmc = 5245728 | doi = 10.5152/UCD.2016.3683 }}</ref> Laparoscopic cholecystectomy has a higher risk of bile duct injury than the open approach, with injury to bile ducts occurring in 0.3% to 0.5% of laparoscopic cases and 0.1% to 0.2% of open cases.<ref name="Stewart_2014">{{cite journal | vauthors = Stewart L | title = Iatrogenic biliary injuries: identification, classification, and management | journal = The Surgical Clinics of North America | volume = 94 | issue = 2 | pages = 297–310 | date = April 2014 | pmid = 24679422 | doi = 10.1016/j.suc.2014.01.008 }}</ref> In laparoscopic cholecystectomy, approximately 25–30% of biliary injuries are identified during the operation; the rest become apparent in the early post-operative period.<ref name="Greenfields" />{{page needed|date=February 2018}}

Damage to the bile ducts is very serious because it causes leakage of bile into the abdomen. Signs and symptoms of a bile leak include abdominal pain, tenderness, fever and signs of [[sepsis]] several days following surgery, or through laboratory studies as rising [[total bilirubin]] and [[alkaline phosphatase]].<ref name="Abbasoğlu_2016" /> Complications from a bile leak can follow a person for years and can lead to death. Bile leak should always be considered in any patient who is not recovering as expected after cholecystectomy.<ref name="Abbasoğlu_2016" /> Most bile injuries require repair by a surgeon with special training in biliary reconstruction. If biliary injuries are properly treated and repaired, more than 90% of patients can have a long-term successful recovery.<ref name="Stewart_2014" />

Injury of the bile ducts can be prevented and treated by routinely using X-ray investigation of the bile ducts (intraoperative cholangiography (IOC)).<ref name=":0">{{Cite web|url=https://www.sbu.se/en/publications/sbu-assesses/intraoperative-cholangiography-incholecystectomy/|title=Intraoperative cholangiography in cholecystectomy|date=2018-08-17|website=www.sbu.se|publisher=[[Swedish Agency for Health Technology Assessment and Assessment of Social Services]] (SBU)|access-date=2019-09-02}}</ref> This method was [[Health technology assessment|assessed]] by the Swedish [[Swedish Agency for Health Technology Assessment and Assessment of Social Services|SBU]] and routine use deemed to decrease risk of injury and morbidity following unaddressed injury while only increasing cancer rates due to radiation exposure by a lesser fraction.<ref name=":0" />

=== Other complications ===
A review of safety data in laparoscopic cholecystectomy found the following complications to be most common:
{| class="wikitable"
|+Rates of complications other than bile duct injury after laparoscopic cholecystectomy<ref name="Pucher_2018">{{cite journal | vauthors = Pucher PH, Brunt LM, Davies N, Linsk A, Munshi A, Rodriguez HA, Fingerhut A, Fanelli RD, Asbun H, Aggarwal R | title = Outcome trends and safety measures after 30&nbsp;years of laparoscopic cholecystectomy: a systematic review and pooled data analysis | journal = Surgical Endoscopy | volume = 32 | issue = 5 | pages = 2175–83 | date = March 2018 | pmid = 29556977 | pmc = 5897463 | doi= 10.1007/s00464-017-5974-2 }}</ref>
!Complication
!Prevalence
|-
|Wound infection
|1.25%
|-
|[[Urinary retention]]
|0.90%
|-
|Bleeding
|0.79%
|-
|Retained stone in the common bile duct
|0.50%
|-
|Respiratory
|0.48%
|-
|Cardiac
|0.36%
|-
|Intra-abdominal abscess
|0.34%
|-
|[[Hernia]]
|0.21%
|}
The same study found the prevalence of bowel injury, sepsis, pancreatitis, and [[deep vein thrombosis]]/[[pulmonary embolism]] to be around 0.15% each.<ref name="Pucher_2018" />

Leakage from the stump of the cystic duct is a complication that is more common with the laparoscopic approach than the open approach but is still rare, occurring in less than 1% of procedures; it is treated by drainage followed by insertion of a bile duct [[stent]].<ref>{{cite journal | vauthors = Siiki A, Rinta-Kiikka I, Sand J, Laukkarinen J | title = Biodegradable biliary stent in the endoscopic treatment of cystic duct leak after cholecystectomy: the first case report and review of literature | journal = Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A | volume = 25 | issue = 5 | pages = 419–22 | date = May 2015 | pmid = 25853929 | doi = 10.1089/lap.2015.0068 }}</ref>

Another complication singular to the laparoscopic procedure is the phenomenon of the "spilled gallstone" which complicates 0.08–0.3% of cases.<ref>{{cite journal | vauthors = Schafer M, Suter C, Klaiber C, et al. | title = Spilled gallstones after laparoscopic cholecystectomy. A relevant problem? A retrospective analysis of 10,174 laparoscopic cholecystectomies | journal = Surg Endosc | volume = 12 | pages = 291–3 | date = Apr 1998 | issue = 4 | pmid = 9543518 | doi = 10.1007/s004649900659| s2cid = 610548 }}</ref> Here a stone escapes the resected gallbladder into the [[abdomen]] where it can become a [[Focal infection theory|focus for infection]] if it is not identified and removed.<ref>{{cite journal | vauthors = Satesh-Kumar T, Saklani A, Vinayagam R, Blackett R | title = Spilled gall stones during laparoscopic cholecystectomy: a review of the literature | journal = Postgrad Med J| volume = 80 | issue = 940 | pages = 77–9 | date = Feb 2004 | pmid = 14970293 | doi=10.1136/pmj.2003.006023 | pmc = 1742934 }}</ref> Some reports exist of spilled stones lying unnoticed for up to 20 years before eventually causing an [[abscess]] to form.<ref>{{cite journal | vauthors = Nugent L, Chandran P| title = Need brooks no delay. Peritoneo-cutaneous fistula formation secondary to gallstone dropped at laparoscopic cholecystectomy 20 years previously: a case report | journal = Journal of Surgical Case Reports| volume = 2018 | article-number = rjy013 | date = Feb 2018| issue = 2 | pmid = 29479416 | doi=10.1093/jscr/rjy013 | pmc = 5811847 }}</ref>

=== Conversion to open cholecystectomy ===
Experts agree that many biliary injuries in laparoscopic cases are caused by difficulties seeing and identifying the anatomy clearly. If the surgeon has problems identifying anatomical structures, they might need to convert from laparoscopic to open cholecystectomy.<ref>{{cite journal | vauthors = Malik AM, Laghari AA, Talpur AH, Khan A | title = Iatrogenic biliary injuries during laparoscopic cholecystectomy. A continuing threat | journal = International Journal of Surgery | volume = 6 | issue = 5 | pages = 392–5 | date = October 2008 | pmid = 18823829 | doi = 10.1016/j.ijsu.2008.07.005 | doi-access = free }}</ref>

'''<big>Peroperative Endoscopic Retrograde Cholangio-Pancreaticography (ERCP)/ Laparo-endoscopic rendezvous (LERV) technique</big>'''

CBDS are found in 10–15% of patients during cholecystectomy when intraoperative cholangiography (IOC) is routinely performed.<ref>{{cite web |vauthors=Persson G, Enochsson L, Sandblom G |title=Årsrapport för Svenskt Kvalitetsregister för gallstenskirurgi |date=8 August 2017 |work=GallRiks |publisher= |url=http://www.ucr.uu.se/gallriks/}}</ref>
<ref>{{cite journal |vauthors=Möller M, Gustafsson U, Rasmussen F, Persson G, Thorell A |title=Natural course vs interventions to clear common bile duct stones: data from the Swedish Registry for Gallstone Surgery and Endoscopic Retrograde Cholangiopancreatography (GallRiks) |journal=JAMA Surg |volume=149 |issue=10 |pages=1008–13 |date=October 2014 |pmid=25133326 |doi=10.1001/jamasurg.2014.249 }}</ref>
There are several strategies to manage choledocholithiasis but the optimal method as well as the timing of treatment is still under debate.<ref>{{cite journal |vauthors=Rábago LR, Vicente C, Soler F, Delgado M, Moral I, Guerra I, Castro JL, Quintanilla E, Romeo J, Llorente R, Vázquez Echarri J, Martínez-Veiga JL, Gea F |title=Two-stage treatment with preoperative endoscopic retrograde cholangiopancreatography (ERCP) compared with single-stage treatment with intraoperative ERCP for patients with symptomatic cholelithiasis with possible choledocholithiasis |journal=Endoscopy |volume=38 |issue=8 |pages=779–86 |date=August 2006 |pmid=17001567 |doi=10.1055/s-2006-944617 }}</ref>

In recent years the LERV technique, in which access to the common bile duct by ERCP is facilitated by an antegrade guidewire, which is intraoperatively introduced during fluoroscopy and is advanced through the cystic duct to the duodenum, has been established as an alternative to treat common bile duct stones discovered during laparoscopic cholecystectomy. This technique was first described in 1993 by Deslandres et al.<ref>{{cite journal |vauthors=Deslandres E, Gagner M, Pomp A, Rheault M, Leduc R, Clermont R, Gratton J, Bernard EJ |title=Intraoperative endoscopic sphincterotomy for common bile duct stones during laparoscopic cholecystectomy |journal=Gastrointest Endosc |volume=39 |issue=1 |pages=54–8 |date=1993 |pmid=8454146 |doi=10.1016/s0016-5107(93)70011-5 }}</ref>
and has, in several studies, been shown to have a high rate of CBD stones clearance and a reduced number of complications, particularly post-ERCP pancreatitis,  in comparison with conventional ERCP.<ref>{{cite journal |vauthors=Swahn F, Regnér S, Enochsson L, Lundell L, Permert J, Nilsson M, Thorlacius H, Arnelo U |title=Endoscopic retrograde cholangiopancreatography with rendezvous cannulation reduces pancreatic injury |journal=World J Gastroenterol |volume=19 |issue=36 |pages=6026–34 |date=September 2013 |pmid=24106403 |pmc=3785624 |doi=10.3748/wjg.v19.i36.6026 |doi-access=free }}</ref>
<ref>{{cite journal |vauthors=Tzovaras G, Baloyiannis I, Zachari E, Symeonidis D, Zacharoulis D, Kapsoritakis A, Paroutoglou G, Potamianos S |title=Laparoendoscopic rendezvous versus preoperative ERCP and laparoscopic cholecystectomy for the management of cholecysto-choledocholithiasis: interim analysis of a controlled randomized trial |journal=Ann Surg |volume=255 |issue=3 |pages=435–9 |date=March 2012 |pmid=22261836 |doi=10.1097/SLA.0b013e3182456ec0 }}</ref>
This is probably due to the facilitated access to the common bile duct with a lesser degree of manipulation and trauma to the papilla Vateri. In a study by Swahn et al. the rendezvous method was shown to reduce the risk of PEP from 3.6 to 2.2% compared with conventional biliary cannulation.<ref>{{cite journal |vauthors=Swahn F, Nilsson M, Arnelo U, Löhr M, Persson G, Enochsson L |title=Rendezvous cannulation technique reduces post-ERCP pancreatitis: a prospective nationwide study of 12,718 ERCP procedures |journal=Am J Gastroenterol |volume=108 |issue=4 |pages=552–9 |date=April 2013 |pmid=23419386 |doi=10.1038/ajg.2012.470 }}</ref>
The success rate of passing the transcystic guidewire into the duodenum has been reported to be over 80%.<ref>{{cite journal |vauthors=Tommasi C, Bencini L, Bernini M, Naspetti R, Cavallina G, Manetti R, Talamucci L, Farsi M |title=Routine use of simultaneous laparoendoscopic approach in patients with confirmed gallbladder and bile duct stones: fit for laparoscopy fit for "rendezvous" |journal=World J Surg |volume=37 |issue=5 |pages=999–1005 |date=May 2013 |pmid=23430003 |doi=10.1007/s00268-013-1962-4 |hdl=11380/1331722 |hdl-access=free }}</ref>

==Procedure==
[[File:Male abdo post lap chole.JPG|thumb|Abdomen of a 45-year-old male approximately one month after a laparoscopic cholecystectomy. Surgical incision points are highlighted; the point at top right is barely visible. The gall bladder was removed via the incision at the navel. There is a fourth incision (not shown) on the person's right lower flank, used for draining. All incisions have healed well and the most visible remaining effect of surgery is from the pre-operative [[hair removal]].]]
[[File:Steps of cholecystectomy as seen through a laparoscope.png|thumb|Steps of a cholecystectomy, as seen through a laparoscope]]
[[File:Laparoscopic Cholecystectomy Incisions, 1 Week Old.jpg|thumb|The 1-week-old incisions of a post-operative laparoscopic cholecystectomy as indicated by red arrows.  The 3 abdominal incisions are approximately 6mm, while the fourth incision near the umbilicus is 18mm, each closed with dissolvable sutures.  Minor inflammation can be seen surrounding each site due to skin irritation caused by removal of [[Tegaderm]] dressings.]]

===Pre-operative preparation===
Before surgery, a [[complete blood count]] and [[liver function tests]] are usually obtained.<ref name="Schwartz">{{cite book | first1 = F. Charles | last1 = Brunicardi | first2 = Dana K. | last2 = Andersen | first3 = David L. | last3 = Dunn | first4 = John G. | last4 = Hunter  | first5 = Jeffrey B. | last5 = Matthews | first6 = Raphael E. | last6 = Pollock | first7 = Timothy R. | last7 = Billiar | name-list-style = vanc | title = Schwartz's principles of surgery|date=2014| publisher = McGraw-Hill Education |isbn=978-0-07-179674-3 | edition = 10th }}</ref> [[Thrombosis prevention|Prophylactic treatment]] is given to prevent deep vein thrombosis.<ref name="Schwartz" /> Use of prophylactic antibiotics is controversial; however, a dose may be given prior to surgery to prevent infection in certain people at high risk.<ref>{{cite journal | vauthors = Sanabria A, Dominguez LC, Valdivieso E, Gomez G | title = Antibiotic prophylaxis for patients undergoing elective laparoscopic cholecystectomy | journal = The Cochrane Database of Systematic Reviews | issue = 12 | article-number = CD005265 | date = December 2010 | pmid = 21154360 | doi = 10.1002/14651858.CD005265.pub2 | hdl = 10818/49624 | hdl-access = free | pmc = 12278356 }}</ref><ref name="Overby">{{cite journal | vauthors = Overby DW, Apelgren KN, Richardson W, Fanelli R | title = SAGES guidelines for the clinical application of laparoscopic biliary tract surgery | journal = Surgical Endoscopy | volume = 24 | issue = 10 | pages = 2368–86 | date = October 2010 | pmid = 20706739 | doi = 10.1007/s00464-010-1268-7 | s2cid = 10656813 | url = https://revista.spcir.com/index.php/spcir/article/view/64 }}</ref> Gas may be removed from the stomach with an [[Nasogastric intubation|OG or NG tube]].<ref name="Schwartz" /> A [[Foley catheter]] may be used to empty the patient's bladder.<ref name="Schwartz" />

===Laparoscopic cholecystectomy===
[[Laparoscopy|Laparoscopic]] cholecystectomy uses several (usually 4) small incisions in the abdomen to allow the insertion of operating ports, small cylindrical tubes approximately 5 to 10&nbsp;mm in diameter, through which surgical instruments are placed into the [[abdominal cavity]]. The [[laparoscopy|laparoscope]], an instrument with a video camera and light source at the end, illuminates the abdominal cavity and sends a magnified image from inside the abdomen to a video screen, giving the surgeon a clear view of the organs and tissues. The [[cystic duct]] and [[cystic artery]] are identified and dissected, then [[Ligature (medicine)|ligated]] with clips and cut in order to remove the gallbladder. The gallbladder is then removed through one of the ports.<ref name=Shackelford8th/>

As of 2008, 90% of cholecystectomies in the United States were done laparoscopically.<ref name="Ingraham">{{cite journal | vauthors = Ingraham AM, Cohen ME, Ko CY, Hall BL | title = A current profile and assessment of north American cholecystectomy: results from the American college of surgeons national surgical quality improvement program | journal = Journal of the American College of Surgeons | volume = 211 | issue = 2 | pages = 176–86 | date = August 2010 | pmid = 20670855 | doi = 10.1016/j.jamcollsurg.2010.04.003 }}</ref> Laparoscopic surgery is thought to have fewer complications, shorter hospital stay, and quicker recovery than open cholecystectomy.<ref>{{cite journal | vauthors = Yamashita Y, Takada T, Kawarada Y, Nimura Y, Hirota M, Miura F, Mayumi T, Yoshida M, Strasberg S, Pitt HA, de Santibanes E, Belghiti J, Büchler MW, Gouma DJ, Fan ST, Hilvano SC, Lau JW, Kim SW, Belli G, Windsor JA, Liau KH, Sachakul V | title = Surgical treatment of patients with acute cholecystitis: Tokyo Guidelines | journal = Journal of Hepato-Biliary-Pancreatic Surgery | volume = 14 | issue = 1 | pages = 91–7 | date = January 2007 | pmid = 17252302 | pmc = 2784499 | doi = 10.1007/s00534-006-1161-x }}</ref>

==== Single incision ====
Single incision laparoscopic surgery ([[Single-port laparoscopy|SILS]]) or laparoendoscopic single site surgery (LESS) is a technique in which a single incision is made through the [[navel]], instead of the 3-4 four small different incisions used in standard laparoscopy.  There appears to be a cosmetic benefit over conventional four-hole laparoscopic cholecystectomy, and no advantage in postoperative pain and hospital stay compared with standard laparoscopic procedures.<ref name=Lirici2016/> There is no scientific consensus regarding risk for [[bile duct injury]] with SILS versus traditional laparoscopic cholecystectomy.<ref name=Lirici2016>{{cite journal | vauthors = Lirici MM, Tierno SM, Ponzano C | title = Single-incision laparoscopic cholecystectomy: does it work? A systematic review | journal = Surgical Endoscopy | volume = 30 | issue = 10 | pages = 4389–99 | date = October 2016 | pmid = 26895901 | doi = 10.1007/s00464-016-4757-5 | s2cid = 5966494 }}</ref>

====Natural orifice transluminal====
Natural orifice transluminal endoscopic surgery ([[Natural orifice transluminal endoscopic surgery|NOTES]]) is an experimental technique where the laparoscope is inserted through natural orifices and internal incisions, rather than skin incisions, to access to the abdominal cavity.<ref name="Gaillard">{{cite journal | vauthors = Gaillard M, Tranchart H, Lainas P, Dagher I | title = New minimally invasive approaches for cholecystectomy: Review of literature | journal = World Journal of Gastrointestinal Surgery | volume = 7 | issue = 10 | pages = 243–8 | date = October 2015 | pmid = 26523212 | pmc = 4621474 | doi = 10.4240/wjgs.v7.i10.243 | doi-access = free }}</ref> This offers the potential to eliminate visible scars.<ref name="Chamberlain" /> Since 2007, cholecystectomy by NOTES has been performed anecdotally via transgastric and transvaginal routes.<ref name="Gaillard" /> As of 2009 the risk of [[Gastrointestinal perforation|gastrointestinal leak]], difficulty visualizing the abdominal cavity and other technical limitations limited further adoption of NOTES for cholecystectomy.<ref name="Chamberlain">{{cite journal | vauthors = Chamberlain RS, Sakpal SV | title = A comprehensive review of single-incision laparoscopic surgery (SILS) and natural orifice transluminal endoscopic surgery (NOTES) techniques for cholecystectomy | journal = Journal of Gastrointestinal Surgery | volume = 13 | issue = 9 | pages = 1733–40 | date = September 2009 | pmid = 19412642 | doi = 10.1007/s11605-009-0902-y | s2cid = 8037138 }}</ref>

===Open cholecystectomy===
In open cholecystectomy, a surgical incision of around 8 to 12&nbsp;cm is made below the edge of the right rib cage and the gallbladder is removed through this large opening, typically using [[electrocautery]].<ref name=Shackelford8th/> Open cholecystectomy is often done if difficulties arise during a laparoscopic cholecystectomy, for example, the patient has unusual anatomy, the surgeon cannot see well enough through the camera, or the patient is found to have cancer.<ref name=Shackelford8th/> It can also be done if the patient has severe [[cholecystitis]], emphysematous gallbladder, [[Fistula|fistulization]] of gallbladder and [[gallstone ileus]], [[Ascending cholangitis|cholangitis]], [[cirrhosis]] or [[portal hypertension]], and [[Dyscrasia|blood dyscrasias]].<ref name=Shackelford8th/>

===Biopsy===
After removal, the gallbladder should be sent for pathological examination to confirm the diagnosis and look for any incidental cancer. Incidental cancer of the gallbladder is found in approximately 1% of cholecystectomies.<ref name=Goldman2011/>{{rp|1019}}  If cancer is present in the gallbladder, it is usually necessary to re-operate to remove parts of the liver and lymph nodes and test them for additional cancer.<ref>{{cite journal | vauthors = Kapoor VK | title = Incidental gallbladder cancer | journal = The American Journal of Gastroenterology | volume = 96 | issue = 3 | pages = 627–9 | date = March 2001 | doi = 10.1111/j.1572-0241.2001.03597.x | pmid = 11280526 | s2cid = 28999270 | doi-access = free }}</ref>

===Post-operative management===
After surgery, most patients are admitted to the hospital for routine monitoring. For uncomplicated laparoscopic cholecystectomies, people may be discharged on the day of surgery after adequate control of pain and nausea.<ref name="Overby" /> Patients who were high-risk, those who required emergency surgery, and/or those undergoing open cholecystectomy usually need to stay in the hospital several days after surgery.<ref name="SSAT" />

=== Subtotal Cholecystectomy ===
Intra-operative decisions, with patient safety at the forefront, sometimes call for what is known in surgical education as "bail-out" procedures. This is usually due to the surgical team making a clinical decision in the operating room to not proceed with the intended cholecystectomy, due to issues such as adherent bowel or colon, or inability to properly identify anatomical planes from previously formed scar-tissue. If there is any inability to safely isolate the cystic duct and cystic artery structures needed for cholecystectomy – such as an aforementioned adherent bowel, the separation of which often results in an accidental hole thereto – the surgical team may elect to do a subtotal cholecystectomy, of either a fenestrated or reconstituting type.<ref>{{Cite journal |last=Lunevicius |first=R |date=April 2020 |title=Laparoscopic subtotal cholecystectomy: a classification, which encompasses the variants, technical modalities, and extent of resection of the gallbladder |journal=The Annals of the Royal College of Surgeons of England |volume=102 |issue=4 |pages=315–7 |doi=10.1308/rcsann.2020.0007 |pmc=7099162 |pmid=32003580}}</ref> Essentially, only part of the gall bladder is removed and a drain is left in place for several days. Complications include continued output from the drain, which may result in the need for an [[Endoscopic retrograde cholangiopancreatography|ERCP]] stent placement to stop drainage.

==Long-term prognosis==
In 95% of people undergoing cholecystectomy as treatment for simple biliary colic, removing the gallbladder completely resolves their symptoms.<ref name=CurrentSurg2015/>

Up to 10% of people who undergo cholecystectomy develop a condition called [[postcholecystectomy syndrome]].<ref name=Jaunoo2010>{{cite journal | vauthors = Jaunoo SS, Mohandas S, Almond LM | title = Postcholecystectomy syndrome (PCS) | journal = International Journal of Surgery | volume = 8 | issue = 1 | pages = 15–7 | date = 2010 | pmid = 19857610 | doi = 10.1016/j.ijsu.2009.10.008 | doi-access = free }}{{open access}}</ref>  Symptoms are typically similar to the pain and discomfort of biliary colic with persistent pain in the upper right abdomen and commonly include gastrointestinal distress ([[dyspepsia]]).<ref name=Jaunoo2010/>

Some people following cholecystectomy may develop [[diarrhea]].<ref name=Sabiston20th/>  The cause is unclear, but is presumed to be due to disturbances in the biliary system that speed up [[Enterohepatic circulation|enterohepatic]] recycling of [[Bile acid|bile salts]]. The [[Ileum|terminal ileum]], the portion of the intestine where these salts are normally reabsorbed, becomes overwhelmed, does not absorb everything, and the person develops [[diarrhea]].<ref name=Sabiston20th/> Most cases resolve within weeks or a few months, though in rare cases the condition can last for years. It can be controlled with medication such as [[cholestyramine]].{{medical citation needed|date=March 2018}}

A systematic review and meta analysis of eighteen studies on the association between cholecystectomy and the risk of development of [[colorectal cancer]] concluded that cholecystecomy has no effect on the risk of colorectal cancer overall, but does have a harmful effect on the risk of right-sided colon cancer.<ref>{{cite journal |vauthors=Mu L, Li W, Ren W, Hu D, Song Y |title=The association between cholecystectomy and the risk of colorectal cancer: an updated systematic review and meta-analysis of cohort studies |journal=Transl Cancer Res |volume=12 |issue=6 |pages=1452–65 |date=June 2023 |pmid=37434692 |pmc=10331452 |doi=10.21037/tcr-22-2049 |doi-access=free }}</ref>  A nationwide cohort study in Korea reported a significantly increased total cancer risk, including increased risk of several different specific types of cancer, after cholecystectomy.<ref>{{cite journal |vauthors=Choi YJ, Jin EH, Lim JH, Shin CM, Kim N, Han K, Lee DH |title=Increased Risk of Cancer after Cholecystectomy: A Nationwide Cohort Study in Korea including 123,295 Patients |journal=Gut Liver |volume=16 |issue=3 |pages=465–473 |date=May 2022 |pmid=35502586 |pmc=9099388 |doi=10.5009/gnl210009 }}</ref>

==Considerations==

=== Pregnancy ===
It is generally safe for pregnant women to undergo laparoscopic cholecystectomy during any trimester of pregnancy.<ref name=Consensus2015/> Early elective surgery is recommended for women with symptomatic gallstones to decrease the risk of spontaneous abortion and pre-term delivery.<ref name=Consensus2015/> Without cholecystectomy, more than half of such women will have recurrent symptoms during their pregnancy, and nearly one in four will develop a complication, such as acute cholecystitis, that requires urgent surgery.<ref name=Consensus2015/> Acute cholecystitis is the second most common cause of [[acute abdomen]] in pregnant women after appendectomy.<ref name=Tokyo2007/>

=== Porcelain gallbladder ===
[[Porcelain gallbladder]] (PGB), a condition where the gallbladder wall shows calcification on imaging tests, was previously considered a reason to remove the gallbladder because it was thought that people with this condition had a high risk of developing gallbladder cancer.<ref name=AFP2014/> However, recent studies have shown that there is no strong association between gallbladder cancer and porcelain gallbladder, and that PGB alone is not a strong enough indication for a prophylactic cholecystectomy.<ref name=Consensus2015/>

==Alternatives to surgery==
There are several alternatives to cholecystectomy for people who do not want surgery, or in whom the benefits of surgery would not outweigh the risks.

=== Conservative management ===
Conservative management for biliary colic involves a "watch and wait" approach—treating symptoms as-needed with oral medications. Experts agree that this is the preferred treatment for people with gallstones but no symptoms.<ref name="Consensus2015" /> Conservative management may also be appropriate for people with mild biliary colic, as the pain from colic can be managed with pain medications like [[Nonsteroidal anti-inflammatory drug|NSAIDs]] (ex: ketorolac) or [[opioid]]s.<ref name="AFP2014" />

Conservative management for acute cholecystitis involves treating the infection without surgery. It is usually only considered in patients at very high risk for surgery or other interventions listed below. It consists of treatment with intravenous antibiotics and fluids.<ref name="Gurusamy_2013" />

=== ERCP ===
[[File:Detailed diagram of an endoscopic retrograde cholangio pancreatography (ERCP) CRUK 001.svg|thumb|In ERCP, the endoscope enters through the mouth and passes through the stomach and start of the small intestine to reach the bile ducts.]]
[[File:Cholangiogram with labels.jpg|thumb|This is a [[Cholangiography|cholangiogram]], an x-ray of the bile ducts using contrast medium to make the bile ducts visible. 1 – Duodenum. 2 – Common bile duct. 3 – Cystic duct. 4 – Hepatic duct. The gallbladder is not seen as the cystic duct is occluded by a surgical instrument.]]
ERCP, short for [[endoscopic retrograde cholangiopancreatography]], is an [[Endoscopy|endoscopic]] procedure that can remove gallstones or prevent blockages by widening parts of the bile duct where gallstones frequently get stuck. ERCP is often used to retrieve stones stuck in the common bile duct in patients with gallstone pancreatitis or cholangitis. In this procedure, an endoscope, or small, long thin tube with a camera on the end, is passed through the mouth and down the esophagus. The doctor advances the camera through the stomach and into the first part of the small intestine to reach the opening of the bile duct. The doctor can inject a special, radiopaque dye through the endoscope into the bile duct to see stones or other blockages on x-ray.<ref>{{Cite web|url=https://medlineplus.gov/ency/article/007479.htm|title=ERCP: MedlinePlus Medical Encyclopedia|website=medlineplus.gov|access-date=2018-03-19}}</ref>  ERCP does not require general anaesthesia and can be done outside of the operating room. While ERCP can be used to remove a specific stone that is causing a blockage to allow drainage, it cannot remove all stones in the gallbladder. Thus, it is not considered a definitive treatment and people with recurrent complications from stones will still likely need a cholecystectomy.{{citation needed|date=January 2022}}

=== Cholecystostomy ===
[[Cholecystostomy]] is the drainage of the gallbladder via insertion of a small tube through the abdominal wall. This is usually done using guidance from imaging scans to find the right place to insert the tube. Cholecystostomy can be used for people who need immediate drainage of the gallbladder but have a high risk of complications from surgery under general anaesthesia, such as elderly people and those with co-existing illnesses.<ref name="Gurusamy_2013">{{cite journal | vauthors = Gurusamy KS, Rossi M, Davidson BR | title = Percutaneous cholecystostomy for high-risk surgical patients with acute calculous cholecystitis | journal = The Cochrane Database of Systematic Reviews | issue = 8 | article-number = CD007088 | date = August 2013 | pmid = 23939652 | doi = 10.1002/14651858.CD007088.pub2 }}</ref> Draining pus and infected material through the tube reduces inflammation in and around the gallbladder. It can be a lifesaving procedure, without requiring that the person undergo emergency surgery.<ref name="Furtado_2016">{{cite journal | vauthors = Furtado R, Le Page P, Dunn G, Falk GL | title = High rate of common bile duct stones and postoperative abscess following percutaneous cholecystostomy | journal = Annals of the Royal College of Surgeons of England | volume = 98 | issue = 2 | pages = 102–6 | date = February 2016 | pmid = 26741665 | pmc = 5210469 | doi = 10.1308/rcsann.2016.0004 }}</ref>

The procedure does come with significant risks and complications—in one retrospective study of patients who received percutaneous cholecystostomy for acute cholecystitis, 44% developed [[Common bile duct stone|choledocholithiasis]] (one or more stones stuck in the common bile duct), 27% had tube dislodgment, and 23% developed postoperative abscess.<ref name="Furtado_2016" />

For some people, drainage with cholecystostomy is enough and they do not need to have the gallbladder removed later. For others, percutaneous cholecystostomy allows them to improve enough in the short term that they can get surgery at a later time.<ref name="Gurusamy_2013" /> There is no clear evidence one way or another to indicate that surgical removal after cholecystostomy is best for high-risk surgical patients with acute cholecystitis.<ref name="Gurusamy_2013" />

==Frequency of use==
About 600,000 people receive a cholecystectomy in the United States each year.<ref name=Goldman2011/>{{rp|855}}

In a study of Medicaid-covered and uninsured U.S. hospital stays in 2012, cholecystectomy was the most common operating room procedure.<ref>{{cite journal |vauthors=Lopez-Gonzalez L, Pickens GT, Washington R, Weiss AJ | title =  Characteristics of Medicaid and Uninsured Hospitalizations, 2012 | journal =HCUP Statistical Brief |issue=183 | publisher = Agency for Healthcare Research and Quality | location = Rockville, MD | date = October 2014 | pmid = 25535644 | url = https://www.hcup-us.ahrq.gov/reports/statbriefs/sb182-Medicaid-Uninsured-Hospitalizations-2012.jsp}}</ref>

Gallstones affect approximately 10-15% of the global adult population, with the incidence rising with age and more commonly affecting women. As a result, cholecystectomy is one of the most common abdominal surgeries performed worldwide.<ref>{{Cite journal |last1=Wood |first1=Simon |last2=Lewis |first2=Wyn |last3=Egan |first3=Richard |date=September 2019 |title=Optimising Surgical Technique in Laparoscopic Cholecystectomy: a Review of Intraoperative Interventions |journal=Journal of Gastrointestinal Surgery |volume=23 |issue=9 |pages=1925–1932 |doi=10.1007/s11605-019-04296-9 |pmid=31240555 |issn=1091-255X}}</ref>

== History ==
[[File:Carl Langenbuch.jpg|right|thumb|Carl Langenbuch performed the first successful cholecystectomy in 1882.]]
[[Carl Langenbuch]] performed the first successful cholecystectomy at the Lazarus hospital in [[Berlin]] on July 15, 1882.<ref name="Blumgart" /> Before this, surgical therapy for symptomatic gallstones was limited to [[cholecystostomy]], or gallstone removal.<ref name="Blumgart">{{cite book | first1 = William R | last1 = Jarnagin | first2 = J | last2 = Belghiti | first3 = LH | last3 = Blumgart | name-list-style = vanc |title=Blumgart's surgery of the liver, biliary tract, and pancreas | date = 2012 | publisher = Elsevier Saunders |location=Philadelphia|isbn=978-1-4557-4606-4|page=6|edition= 5th }}</ref>  Langenbuch's rationale for developing the new technique stemmed from 17th century studies in dogs that demonstrated the gallbladder to be nonessential and medical opinion among his colleagues that gallstones formed in the gallbladder.<ref name="Blumgart" /> Although the technique was initially controversial, cholecystectomy became established as a lower mortality procedure than cholecystostomy by the 20th century.<ref name="Blumgart" />

=== Laparoscopic technique ===
[[Erich Mühe]] performed the first laparoscopic cholecystectomy on September 12, 1985, in [[Böblingen, Germany]].<ref>{{cite journal |vauthors=Reynolds W |title=The first laparoscopic cholecystectomy |journal=JSLS |volume=5 |issue=1 |pages=89–94 |date=2001 |pmid=11304004 |pmc=3015420 }}</ref> Mühe was inspired to develop a technique for laparoscopic cholecystectomy by the first laparoscopic [[appendectomy]], performed by [[gynecologist]] [[Kurt Semm]] in 1980.<ref name="Polychronidis" /> He subsequently designed an optical laparoscope with a working channel large enough to fit a distended gallbladder.<ref name="Polychronidis">{{cite journal | vauthors = Polychronidis A, Laftsidis P, Bounovas A, Simopoulos C | title = Twenty years of laparoscopic cholecystectomy: Philippe Mouret--March 17, 1987 | journal = JSLS | volume = 12 | issue = 1 | pages = 109–11 | date = 2008 | pmid = 18402752 | pmc = 3016026 }}</ref> Mühe presented his technique to the Congress of the German Surgical Society in 1986, claiming reduced postoperative pain and shorter hospitalization.<ref name="Litynski">{{cite journal | vauthors = Litynski GS | title = Erich Mühe and the rejection of laparoscopic cholecystectomy (1985): a surgeon ahead of his time | journal = JSLS | volume = 2 | issue = 4 | pages = 341–6 | date = 1998 | pmid = 10036125 | pmc = 3015244 }}</ref> His work was met with strong resistance by the German surgical establishment and he had difficulty communicating it in English. It was consequently ignored.<ref name="Polychronidis" /> Mühe's work was further disparaged in 1987, when he was charged with manslaughter for a postoperative patient death that was mistakenly attributed to his innovative technique.<ref name=gsn>{{cite web|url=http://www.generalsurgerynews.com/In-the-News/Article/06-13/The-first-Lap-Chole-in-Europe-A-%E2%80%98Criminal%E2%80%99-Is-Vindicated/23368/ses=ogst|title= The first Lap Chole in Europe: A 'Criminal' Is Vindicated|date=10 June 2013|first=Victoria|last=Stern | name-list-style = vanc |work=General Surgery News|access-date=4 October 2017}}</ref> He was exonerated in 1990 after further investigation.<ref name="gsn" /> His pioneering work was eventually recognized by the German Surgical Society Congress in 1992.<ref name="Polychronidis" />

Philippe Mouret performed laparoscopic cholecystectomy on March 17, 1987, in [[Lyon, France]].<ref name="Polychronidis" /> His technique was rapidly adopted and improved in France.<ref name="Polychronidis" /> It was subsequently introduced to the rest of the world over the next three years.<ref name="Polychronidis" /> Driven by popularity among patients, the laparoscopic technique became preferred over open surgery and noninvasive treatments for gallstones.<ref name="Polychronidis" />

By 2013, [[laparoscopic surgery|laparoscopic]] cholecystectomy had replaced open cholecystectomy as the first-choice of treatment for people with uncomplicated [[gallstone]]s and [[Cholecystitis|acute cholecystitis]].<ref name="Shackelford8th">{{Cite book|title=Shackelford's surgery of the alimentary tract.|others=Yeo, Charles J.|year=2018|isbn=978-0-323-40232-3 |edition=8th |publisher=Elsevier |location=Philadelphia, PA|oclc=1003489504|last1=Yeo|first1=Charles J.}}</ref><ref>{{cite journal | vauthors = Coccolini F, Catena F, Pisano M, Gheza F, Fagiuoli S, Di Saverio S, Leandro G, Montori G, Ceresoli M, Corbella D, Sartelli M, Sugrue M, Ansaloni L | title = Open versus laparoscopic cholecystectomy in acute cholecystitis. Systematic review and meta-analysis | journal = International Journal of Surgery | volume = 18 | pages = 196–204 | date = June 2015 | pmid = 25958296 | doi = 10.1016/j.ijsu.2015.04.083 | doi-access = free }}{{open access}}</ref>

By 2014 laparoscopic cholecystectomy had become the [[Gold standard (test)|gold standard]] for the treatment of symptomatic gallstones.<ref name="Schwartz" /><ref>{{Cite book|title=Laparoscopic Cholecystectomy: an Evidence-based Guide|date=2014|others=Agresta, Ferdinando, Campanile, Fabio Cesare, Vettoretto, Nereo|isbn=978-3-319-05407-0 |publisher=Springer |location=Cham [Switzerland]|oclc=880422516|last1=Agresta|first1=Ferdinando|last2=Campanile|first2=Fabio Cesare|last3=Vettoretto|first3=Nereo}}</ref>

Laparoscopic cholecystectomy can be a challenging procedure and surgeons must be trained with advanced laparoscopic skills to complete the operation with safety and effectiveness.<ref>{{Cite journal|last1=Mulita|first1=Francesk|last2=Benetatos|first2=Nikolaos|last3=Maroulis|first3=Ioannis|last4=Germanos|first4=Stylianos|date=2021-01-18|title=Enlarged cystic artery|journal=BMJ Case Reports|volume=14|issue=1|article-number=e240056|doi=10.1136/bcr-2020-240056 |pmc=7816909|pmid=33462065}}</ref>

== See also ==
* [[List of surgeries by type]]
* [[List of -ectomies]]
* [[Waltman Walter syndrome]]
{{Clear}}

== References ==
{{reflist}}

== Further reading ==
*{{cite web|title=Operation Brochures for Patients: Cholecystectomy|url=https://www.facs.org/~/media/files/education/patient%20ed/cholesys.ashx|website=American College of Surgeons|access-date=2018-03-20|archive-date=2019-08-01|archive-url=https://web.archive.org/web/20190801005339/https://www.facs.org/~/media/files/education/patient%20ed/cholesys.ashx}}
*{{cite web |title=Gallbladder removal |url=https://www.nhs.uk/conditions/gallbladder-removal/ |website=NHS |date=23 October 2017 |access-date=4 January 2020}}

{{Digestive system surgical procedures}}

[[Category:Accessory digestive gland surgery]]
[[Category:Surgical removal procedures]]