Open Cholecystectomy

Excerpt

Gallbladder disease is one of the most common procedures done in the United States with more than 1.2 million cholecystectomies done annually. Before 1991, an open technique was the standard procedure for cholecystectomy. This usually included performing an intraoperative cholangiogram, and patients usually had a 2 to 6-day postoperative in-house stay. With the advent of laparoscopic surgery and laparoscopic cholecystectomy in the late 1980s, the gold standard for cholecystectomy has changed to a laparoscopic approach. This method showed a 30% increase in the overall performance of elective cholecystectomies. Today, 92% of all cholecystectomies are done laparoscopically, although open cholecystectomies remain more common in many less affluent settings. With the advent of laparoscopic cholecystectomies in the 1990s, common bile duct (CBD) injuries increased by three to ten times. The injury rate dropped to 0.3% but has remained the same despite better training, preventative maneuvers, and equipment. Laparoscopic CBD injuries are typically more complex. There are several indications to perform open cholecystectomies, and this procedure remains an important part of training for the general surgery resident.