Which Patients With Gallstones Should Be Treated With Laparoscopic Cholecystectomy?
Most patients with symptomatic gallstones are candidates for laparoscopic cholecystectomy, if they are able to tolerate general anesthesia and have no serious cardiopulmonary diseases or other comorbid conditions that preclude operation. In fact, the indications for laparoscopic cholecystectomy, in general, are similar to those for open cholecystectomy. Indeed, the availability of laparoscopic cholecystectomy should not expand the indications for gallbladder removal. Patients who are usually not candidates for laparoscopic cholecystectomy include those with generalized peritonitis, septic shock from cholangitis, severe acute pancreatitis, end-stage cirrhosis of the liver with portal hypertension, severe coagulopathy unresponsive to treatment, known cancer of the gallbladder, and cholecysto-enteric fistulas. In addition, patients in the third trimester of pregnancy should not usually undergo laparoscopic cholecystectomy, because of risk of damage to the uterus during the procedure. Pati
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