Gallbladder removal, cholecystectomy, can be accomplished by the open surgery or a laparoscopic procedure. Laparoscopic cholecystectomy is the operation of choice in uncomplicated calculous cholecystitis. Open cholecystectomy may be performed in complicated cases or when trained/skilled personal for laparoscopic procedure is not available. Supportive measures are instituted in the meantime to prepare the patient for surgery. These measures include fluid resuscitation and antibiotics. Antibiotic regimens usually consist of a broad spectrum cephalosporin such as ceftriaxone and an antibacterial with good cover against anaerobic bacteria, such as metronidazole.

Removal of the gallbladder may be done by open surgery or a laparoscopic approach. Laparoscopic cholecystectomy is the procedure of choice in uncomplicated calculous cholecystitis. Open cholecystectomy may be performed in complicated cases or when trained or skilled personal for laparoscopic procedure is not available. Supportive measures such as fluid resuscitation and antibiotics are instituted in the meantime to prepare the patient for surgery. Antibiotic regimens usually consist of a broad spectrum cephalosporin such as ceftriaxone and an antibacterial with good cover against anaerobic bacteria, such as metronidazole.^[1][2]

Laparoscopic cholecystectomy is a minimally invasive surgical procedure and has various indications in addition to the chronic cholecystitis. There are two main types of procedures used for the laparoscopic cholecystectomy ; Single-incision laparoscopic cholecystectomy (SILC) and conventional multiport laparoscopic cholecystectomy (CMLC).^[3][4][5][6]

• Single-incision laparoscopic cholecystectomy (SILC)
  • As compared to CMLC, SILC has the following features:
    • Improved cosmetic results
    • Decreased postoperative pain
    • Increased operative time
    • Increased intraoperative blood loss
• Conventional multiport laparoscopic cholecystectomy (CMLC)
  • As compared to SILC, CMLC has the following features:
    • Decreased operative time
    • Decreased intra-operative blood loss

• Indications of laparoscopic cholecystitis are:^[1][2]
  • Cholecystitis (acute/chronic)
  • Symptomatic cholelithiasis
  • Biliary dyskinesia
  • Acalculous cholecystitis
  • Gallstone pancreatitis
  • Gallbladder mass or polyps

The contraindications of laparoscopic cholecystitis include:^[1][2]

• Inability to tolerate pneumoperitoneum or general anesthesia
• Uncorrectable coagulopathy
• Metastatic disease

The major complications associated with the cholecystectomy are:^[7]

• Abscess
• Ascending cholangitis
• Bile duct injury
• Bleeding (liver surface and cystic artery most common sites)
• Hernia
• Pancreatitis
• Perforation or rupture
• Wound infection
• Organ injury (intestine and liver at highest risk, especially if gallbladder through inflammation has become scarred or adherent to other organs (e.g. transverse colon))
• Deep vein thrombosis/pulmonary embolism (unusual- risk can be decreased through use of sequential compression devices on legs during surgery)

Percutaneous cholecystostomy (PC) is an alternative to emergency cholecystectomy in complicated cases of high-risk patients.^[8][9][10]

• The results showed that the mortality, morbidity and conversion rate were the same in PC and laparoscopic cholecystectomy.
• Older patients with increased comorbidities usually undergo cholecystectomy.
• If a patient is not a good surgical candidate at the time of presentation, cholecystectomy is preferred. Patients usually have biliary complications and cholecystectomy is required ultimately.