Cholecystectomy

Cholecystectomy

Anesthesia type	General
Airway	Endotracheal tube
Lines and access	Peripheral IV
Monitors	Standard ASA 5-lead EKG
Primary anesthetic considerations
Preoperative
Intraoperative
Postoperative
Article quality
Editor rating	Certified
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A cholecystectomy is generally performed to treat symptomatic cholelithiasis and other gallbladder conditions. This is one of the most common procedures performed in hospitals in the United States. Of the more than 20 million people in the US with gallstones, about 30% will eventually require cholecystectomy to relieve symptoms or treat complications. A cholecystectomy can be performed laparoscopically or as an open procedure. Surgical practice has largely transitioned to the laparoscopic approach. The rate of conversion to an open operation is 2-3% for elective gallbladder surgery and ~10% for acute cholecystitis.

Preoperative management

Patient evaluation

System	Considerations
Respiratory	Acute abdominal pain can cause respiratory impairment (respiratory splinting) resulting in atelectasis
Cardiovascular
Renal
Gastrointestinal
Hematologic	Sepsis can result in tachycardia, tachypnea, hyperthermia, and leukocytosis/leucopenia
Endocrine
Other

Regional and neuraxial techniques

• Consider epidural for open approach

Intraoperative management

Maintenance and surgical considerations

• Intraoperative insufflation may cause atelectasis, decrease FRC, increase PIPs, and increase CO2

Procedure variants

	Open Cholecystectomy	Laparoscopic Cholecystectomy
Unique considerations
Position	Supine	Supine
Surgical time	2-4 hours	0.5-2 hours
EBL	250mL	Minimal
Postoperative disposition	PACU	PACU
Mortality
Morbidity
Pain	5-7	3