What are contraindications for laparoscopic cholecystectomy?

Updated: Apr 16, 2020
  • Author: Danny A Sherwinter, MD; Chief Editor: Kurt E Roberts, MD  more...
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Answer

Absolute contraindications for laparoscopic cholecystectomy include an inability to tolerate general anesthesia and uncontrolled coagulopathy. Patients with severe obstructive pulmonary disease or congestive heart failure (eg, cardiac ejection fraction <20%) may not tolerate carbon dioxide pneumoperitoneum and may be better served with open cholecystectomy if cholecystectomy is absolutely necessary.

Gallbladder cancer must be considered a contraindication for laparoscopic cholecystectomy. If gallbladder cancer is diagnosed intraoperatively, the operation must be converted to an open procedure. Theoretically, an open procedure allows a more controlled performance, with less chance of spillage; also, lymph nodes can be sampled intraoperatively to stage the disease. [34]

Many conditions once felt to be contraindications for laparoscopic cholecystectomy (eg, gangrenous gallbladder, empyema of the gallbladder, bilioenteric fistulae, obesity, pregnancy, ventriculoperitoneal shunt, previous upper abdominal procedures, cirrhosis, and coagulopathy) are no longer considered contraindications but are acknowledged to require special care and preparation of the patient by the surgeon and careful weighing of risk against benefit.

As surgeons have accumulated extensive experience with the laparoscopic technique, these contraindications have been discounted, and reports abound of successfully performed cases. [35, 36]


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