Anterograde cholecystectomy by laparotomy for acute cholecystitis

Abstract

For the last 20 years, open cholecystectomy by laparotomy for acute cholecystitis has been indicated only when there are contra-indications for laparoscopy or when conversion to an open approach is necessitated by operative difficulties [1]. Contra-indications to laparoscopy include: lack of availability of adequate equipment, the cardio-respiratory complications of prolonged pneumoperitoneum (patients with septic shock, hypovolemia, decompensated congestive heart failure, or bullous emphysema), suspicion of gallbladder cancer, portal hypertension, and coagulopathies. Conversion to laparotomy should not be considered a failure and, in fact, delay in conversion is tied to an increased risk for bile duct injury [2]. Open cholecystectomy for acute cholecystitis is not a rare procedure; data from the PMSI (French national data bank) in September 2014 showed that cholecystectomy for acute cholecystitis was performed through an open approach in 12% of cases during the preceding three years. It is therefore important for recently-trained surgeons to know the open operative technique and the rules for preventing complications in this setting [3].