Technical Aspects of Cholecystectomy

Acute Cholecystitis—Optimal Timing for Early Cholecystectomy: a French Nationwide Study

“…6,7 Consequently, a cholecystectomy is traditionally performed after an initial presentation with acute cholecystitis, 8 with laparoscopic cholecystectomy as the gold standard for the surgical treatment of symptomatic cholelithiasis. 9,10 In recent years, it has been debated whether cholecystectomy should be performed during the initial hospital admission (early cholecystectomy) or more than 6 weeks after the onset of symptoms (delayed cholecystectomy). Several recent studies have shown a shorter length of hospital stay in the early group.…”

Surgical management of acute cholecystitis

“…Several reports have demonstrated that it is technically feasible to perform cholecystectomy with these techniques and with good short-term outcomes [80].…”

“…It may be performed entirely via the natural orifice or using a hybrid technique which involves laparoscopic support via an umbilical port [80]. In a small case series of ten patients [82], six emergency NOTES transvaginal cholecystectomies for acute cholecystitis were successfully performed.…”

“…Importantly, there is no evidence that these techniques are superior to or have proven clinical advantage over existing conventional methods [80]. NOTES and robotic surgery for acute cholecystitis are being introduced in large, academic and tertiary referral units which are ideally positioned to determine their safety and cost-effectiveness before they are more widely implemented.…”

“…The authors proposed that this problem could be avoided by a system whereby one consultant is on call for general surgery for all or part of a week, during which time they have no elective lists or outpatient sessions. Also, focussed surgical training in subspecialty interest may lead to acute cholecystitis becoming the domain of the specialist rather than the generalist [80].…”