Surgical Approach

Surgery is not indicated in asymptomatic patients, except in some select groups (e.g. sickle cell disease) [15]. Surgical treatment choices are based on the patient’s clinical condition: less radical surgical procedures such as endoscopic retrograde cholangiopancreatography (ERCP) are done emergently in sick patients with ascending cholangitis or gall stone pancreatitis.

Comparing laparoscopic and open cholecystectomy, there is no difference between mortality, operating time or complication rate, but there is an extension of hospital stay with open cholecystectomy [16].

Laparoscopic cholecystectomy

Laparoscopic cholecystectomy is shown in Fig 1. In the surgical treatment of acute cholecystitis and biliary colic many centres offer same admission cholecystectomy to patients who are admitted with symptomatic gall stone disease [9]. This has advantages in that morbidity in waiting period, hospital stay and operating time are all reduced.

Learning Bite

Laparoscopic cholecystectomy (increasingly same admission) is the treatment of choice for symptomatic gall stones.

Other surgical options

• Percutaneous cholecystostomy for biliary sepsis in patients with high surgical risk [17]
• ERCP, in patients with gall-stone pancreatitis [18]