What are the SAGES guidelines for laparoscopic surgery in symptomatic gallstones (cholelithiasis)?

Updated: Apr 01, 2019
  • Author: Douglas M Heuman, MD, FACP, FACG, AGAF; Chief Editor: BS Anand, MD  more...
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Answer

The first cholecystectomy was performed in the late 1800s. The open approach pioneered by Langenbuch remained the standard of care until the late 1980s, when laparoscopic cholecystectomy was introduced. [23, 24] Laparoscopic cholecystectomy was the vanguard of the minimally invasive revolution, which has affected nearly all areas of modern surgical practice. Currently, open cholecystectomy is mainly reserved for special situations.

The traditional open approach to cholecystectomy employed a large, right subcostal incision. In contrast, laparoscopic cholecystectomy employs four very small incisions. Recovery time and postoperative pain are diminished markedly by the laparoscopic approach.

Currently, laparoscopic cholecystectomy is commonly performed in an outpatient setting. By reducing inpatient stay and the time lost from work, the laparoscopic approach has also reduced the cost of cholecystectomy. [25]

In its 2010 guidelines for the clinical application of laparoscopic biliary tract surgery, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) states that patients with symptomatic cholelithiasis are eligible for laparoscopic surgery. Cholelithiasis patients whose laparoscopic cholecystectomy was uncomplicated may be sent home the same day if postoperative pain and nausea are well controlled. Patients older than 50 years may be at greater risk of readmission. [26]

During laparoscopic cholecystectomy, a surgeon must retrieve stones that might escape through a perforated gallbladder. Conversion to an open procedure might be required in certain cases.


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