Overview
Open Cholecystectomy is a surgical procedure used to remove the gallbladder through an open abdominal incision. It is an alternative to laparoscopic cholecystectomy in certain situations.
Open cholecystectomy is crucial for treating symptomatic cholelithiasis when laparoscopic approach is contraindicated or unavailable. It provides direct visualization and access to the gallbladder.
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Indications
Gallstones causing symptoms
Inflammation of gallbladder
When laparoscopy not possible
Perforation, abscess
When laparoscopy unavailable
Contraindications
Absolute Contraindications
Relative Contraindications
📋 Equipment Checklist
Check off items as you gather them:
Pre-procedure Preparation
Preparation includes patient consent, preoperative antibiotics, positioning, equipment setup, and team briefing. All team members should understand their roles.Step-by-Step Procedure
Step 1: Patient Preparation
Position patient, prep and drape, administer antibiotics.
⚠️ Common Mistakes to Avoid:
- Poor positioning
- Inadequate prep
- Missed antibiotics
💡 Pro Tip:
Position patient supine with arms abducted.
Step 2: Incision
Make right subcostal or midline incision.
⚠️ Common Mistakes to Avoid:
- Wrong incision
- Too small incision
💡 Pro Tip:
Use right subcostal incision for optimal access.
Step 3: Exploration
Explore abdomen, identify gallbladder.
⚠️ Common Mistakes to Avoid:
- Incomplete exploration
- Missed pathology
💡 Pro Tip:
Always explore for other pathology.
Step 4: Calot Triangle Dissection
Dissect Calot triangle, identify cystic duct and artery.
⚠️ Common Mistakes to Avoid:
- Inadequate dissection
- Bile duct injury
💡 Pro Tip:
Use critical view of safety.
Step 5: Ligation
Ligate cystic duct and artery with sutures.
⚠️ Common Mistakes to Avoid:
- Incomplete ligation
- Bile leak
💡 Pro Tip:
Place ligatures properly to prevent bile leak.
Step 6: Gallbladder Removal
Dissect gallbladder from liver bed.
⚠️ Common Mistakes to Avoid:
- Liver injury
- Bleeding
💡 Pro Tip:
Stay in correct plane to avoid liver injury.
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Post-procedure Care
Post-procedure care involves monitoring for complications, wound care, pain management, and discharge planning when criteria are met.Complications & Management
| Complication | Incidence | Signs | Management | Prevention |
|---|---|---|---|---|
| Bile duct injury | 0.2-0.5% | Bile leak, jaundice | ERCP, surgical repair | Critical view of safety |
| Bleeding | 1-3% | Hemodynamic instability | Exploration, hemostasis | Careful dissection |
| Infection | 5-10% | Fever, wound erythema | Antibiotics, drainage | Preoperative antibiotics |
| Wound dehiscence | 2-5% | Wound separation | Wound care, reclosure | Proper closure technique |
Clinical Pearls
Use right subcostal incision for optimal access.
Always explore for other pathology.
Use critical view of safety.
Place ligatures properly to prevent bile leak.
Stay in correct plane to avoid liver injury.
Close wound properly.
Monitor for complications post-operatively.