Equipment

Equipment for open cholecystectomy includes instruments common to a major instrument tray, as follows:

Kelly clamps, Kocher forceps, needle holders, scissors, clips, suctions, knife/knife handles, forceps, retractors, right-angle clamps, Kitner dissectors, and electrosurgical devices should be assembled
Balfour retractors, Bookwalter retractors, or other self-retaining retractors can be used, according to the surgeon's preference
Sutures or clips can be used to control the cystic duct and artery, depending on the surgeon's preference and the size of the structures (see Technique); long instruments may be needed, depending on the body habitus of the patient

A headlight worn by the operating surgeon or assistant is often valuable in open cholecystectomy for improving visualization.

Several types of cholangiography catheters are available if cholangiography is to be performed.

Anesthesia

Most open cholecystectomies are performed with general anesthesia. Less commonly, the procedure is done with regional (epidural or spinal) anesthesia; in rare instances, it is done with local anesthesia.

Positioning

Patients are positioned supine with the arms extended. Placing a folded blanket or bump underneath the patient's right back or inverting the table may be beneficial.

Technique

El Nakeeb A, Mahdy Y, Salem A, El Sorogy M, El Rafea AA, El Dosoky M, et al. Open Cholecystectomy Has a Place in the Laparoscopic Era: a Retrospective Cohort Study. Indian J Surg. 2017 Oct. 79 (5):437-443. [QxMD MEDLINE Link]. [Full Text].
Riccardi M, Dughayli M, Baidoun F. Open Cholecystectomy for the New Learner-Obstacles and Challenges. JSLS. 2021 Apr-Jun. 25 (2):[QxMD MEDLINE Link]. [Full Text].
Campbell BM, Lambrianides AL, Dulhunty JM. Open cholecystectomy: Exposure and confidence of surgical trainees and new fellows. Int J Surg. 2018 Mar. 51:218-222. [QxMD MEDLINE Link].
Ahmed O, Walsh TN. Surgical Trainee Experience with Open Cholecystectomy and the Dunning-Kruger Effect. J Surg Educ. 2020 Sep - Oct. 77 (5):1076-1081. [QxMD MEDLINE Link].
Fong Y, Jarnagin W, Blumgart LH. Gallbladder cancer: comparison of patients presenting initially for definitive operation with those presenting after prior noncurative intervention. Ann Surg. 2000 Oct. 232 (4):557-69. [QxMD MEDLINE Link].
Wullstein C, Woeste G, Barkhausen S, Gross E, Hopt UT. Do complications related to laparoscopic cholecystectomy influence the prognosis of gallbladder cancer?. Surg Endosc. 2002 May. 16 (5):828-32. [QxMD MEDLINE Link].
Varshney S, Butturini G, Gupta R. Incidental carcinoma of the gallbladder. Eur J Surg Oncol. 2002 Feb. 28 (1):4-10. [QxMD MEDLINE Link].
Sedaghat N, Cao AM, Eslick GD, Cox MR. Laparoscopic versus open cholecystectomy in pregnancy: a systematic review and meta-analysis. Surg Endosc. 2017 Feb. 31 (2):673-679. [QxMD MEDLINE Link].
Babb J, Davis J, Tashiro J, Perez EA, Sola JE, Pandya S. Laparoscopic Versus Open Cholecystectomy in Pediatric Patients: A Propensity Score-Matched Analysis. J Laparoendosc Adv Surg Tech A. 2020 Mar. 30 (3):322-327. [QxMD MEDLINE Link].
McAneny D. Open cholecystectomy. Surg Clin North Am. 2008 Dec. 88 (6):1273-94, ix. [QxMD MEDLINE Link].
Visser BC, Parks RW, Garden OJ. Open cholecystectomy in the laparoendoscopic era. Am J Surg. 2008 Jan. 195 (1):108-14. [QxMD MEDLINE Link].
Livingston EH, Rege RV. A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg. 2004 Sep. 188 (3):205-11. [QxMD MEDLINE Link].
Tang B, Cuschieri A. Conversions during laparoscopic cholecystectomy: risk factors and effects on patient outcome. J Gastrointest Surg. 2006 Jul-Aug. 10 (7):1081-91. [QxMD MEDLINE Link].
Hu ASY, Donohue PO, Gunnarsson RK, de Costa A. External validation of the Cairns Prediction Model (CPM) to predict conversion from laparoscopic to open cholecystectomy. Am J Surg. 2018 Nov. 216 (5):949-954. [QxMD MEDLINE Link].
Al Masri S, Shaib Y, Edelbi M, Tamim H, Jamali F, Batley N, et al. Predicting Conversion from Laparoscopic to Open Cholecystectomy: A Single Institution Retrospective Study. World J Surg. 2018 Aug. 42 (8):2373-2382. [QxMD MEDLINE Link].
Ibrahim S, Hean TK, Ho LS, Ravintharan T, Chye TN, Chee CH. Risk factors for conversion to open surgery in patients undergoing laparoscopic cholecystectomy. World J Surg. 2006 Sep. 30 (9):1698-704. [QxMD MEDLINE Link].
Licciardello A, Arena M, Nicosia A, Di Stefano B, Calì G, Arena G, et al. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy. Eur Rev Med Pharmacol Sci. 2014 Dec. 18 (2 Suppl):60-8. [QxMD MEDLINE Link].
Sutcliffe RP, Hollyman M, Hodson J, Bonney G, Vohra RS, Griffiths EA, et al. Preoperative risk factors for conversion from laparoscopic to open cholecystectomy: a validated risk score derived from a prospective U.K. database of 8820 patients. HPB (Oxford). 2016 Nov. 18 (11):922-928. [QxMD MEDLINE Link].
Kara Y, Kalayci MU. Laparoscopic to Open Cholecystectomy: The Risk Factors and the Reasons; A Retrospective Analysis of 1950 Cases of a Single Tertiary Center. Surg Laparosc Endosc Percutan Tech. 2020 Apr. 30 (2):192-195. [QxMD MEDLINE Link].
Silverstein A, Costas-Chavarri A, Gakwaya MR, Lule J, Mukhopadhyay S, Meara JG, et al. Laparoscopic Versus Open Cholecystectomy: A Cost-Effectiveness Analysis at Rwanda Military Hospital. World J Surg. 2017 May. 41 (5):1225-1233. [QxMD MEDLINE Link].
Strasberg SM, Hertl M, Soper NJ. An analysis of the problem of biliary injury during laparoscopic cholecystectomy. J Am Coll Surg. 1995 Jan. 180 (1):101-25. [QxMD MEDLINE Link].
Sandblom G, Videhult P, Crona Guterstam Y, Svenner A, Sadr-Azodi O. Mortality after a cholecystectomy: a population-based study. HPB (Oxford). 2015 Mar. 17 (3):239-43. [QxMD MEDLINE Link].
A prospective analysis of 1518 laparoscopic cholecystectomies. The Southern Surgeons Club. N Engl J Med. 1991 Apr 18. 324 (16):1073-8. [QxMD MEDLINE Link].
de Goede B, Klitsie PJ, Hagen SM, van Kempen BJ, Spronk S, Metselaar HJ, et al. Meta-analysis of laparoscopic versus open cholecystectomy for patients with liver cirrhosis and symptomatic cholecystolithiasis. Br J Surg. 2013 Jan. 100 (2):209-16. [QxMD MEDLINE Link].
Iannitti DA, Varker KA, Zaydfudim V, McKee J. Subphrenic and pleural abscess due to spilled gallstones. JSLS. 2006 Jan-Mar. 10 (1):101-4. [QxMD MEDLINE Link]. [Full Text].
Metcalfe MS, Ong T, Bruening MH, Iswariah H, Wemyss-Holden SA, Maddern GJ. Is laparoscopic intraoperative cholangiogram a matter of routine?. Am J Surg. 2004 Apr. 187 (4):475-81. [QxMD MEDLINE Link].
McLean TR. Risk management observations from litigation involving laparoscopic cholecystectomy. Arch Surg. 2006 Jul. 141 (7):643-8; discussion 648. [QxMD MEDLINE Link].
Seeras K, Qasawa RN, Kashyap S, Kalani AD. Bile Duct Repair. Treasure Island, FL: StatPearls; 2022. [Full Text].
Kumar S, Kurian N, Singh RK, Chidipotu VR, Kumar S, Raj AK, et al. Surgical management of cystic duct stump calculi causing post-cholecystectomy syndrome: A prospective study. J Minim Access Surg. 2022 Jun 7. [QxMD MEDLINE Link].

Media Gallery

Anatomy and exposure for an open cholecystectomy. Placing packs above liver for improved visualization.
Exposure for open cholecystectomy.
Anatomy, exposure, and beginning of dissection for retrograde technique of open cholecystectomy.
Beginning of dissection for retrograde technique of open cholecystectomy.
Dissecting gallbladder off liver bed in retrograde technique.
Completion of dissection of gallbladder off of liver bed in retrograde technique.
Ligation of cystic duct and artery in retrograde technique of open cholecystectomy.
Completion of retrograde technique of open cholecystectomy showing ligated cystic artery and cystic duct.
Anterograde technique for open cholecystectomy.
Retrograde technique for open cholecystectomy.

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Author

William W Hope, MD Assistant Professor of Surgery, University of North Carolina at Chapel Hill School of Medicine; Director of Surgical Education, Department of Surgery, New Hanover Regional Medical Center/South East Area Health Education Center

William W Hope, MD is a member of the following medical societies: American College of Surgeons, North Carolina Medical Society, Society of American Gastrointestinal and Endoscopic Surgeons

Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Cr bard, WL Gore, Intuitive Surgical<br/>Received research grant from: CR bard, WL Gore<br/>Received income in an amount equal to or greater than $250 from: CR Bard, WL Gore, Intuitive surgical<br/>Received grant/research funds from CR Bard and WL Gore for consulting.

Coauthor(s)

Daniel C Barzana, DO Resident, Department of Surgery, New Hanover Regional Medical Center

Daniel C Barzana, DO is a member of the following medical societies: American College of Surgeons, American Osteopathic Association

Disclosure: Nothing to disclose.

David A Iannitti, MD Clinical Associate Professor of Surgery, University of North Carolina at Chapel Hill School of Medicine; Chief, HepatoPancreaticoBiliary Surgery, Department of General Surgery, Division of Gastrointestinal and Minimally Invasive Surgery, Program Director, HepatoPancreaticoBiliary Surgical Fellowship, Carolinas Medical Center

David A Iannitti, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, International Hepato-Pancreato-Biliary Association, Society for Surgery of the Alimentary Tract, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Surgical Oncology, Americas Hepato-Pancreato-Biliary Association, American Society of Clinical Oncology

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Chief Editor

Kurt E Roberts, MD Associate Professor, Division of Bariatric and Minimally Invasive Surgery, Department of Surgery, Yale University School of Medicine; Chair, Department of Surgery, Saint Francis Hospital, Trinity Health of New England Medical Group

Kurt E Roberts, MD is a member of the following medical societies: American College of Surgeons, Society of American Gastrointestinal and Endoscopic Surgeons, Society of Laparoscopic and Robotic Surgeons

Disclosure: Nothing to disclose.

Additional Contributors

Acknowledgements

The authors thank Cissy Swartz for her assistance with manuscript preparation and editing.