Cholecystectomy was one of the first great MIP success stories. After its introduction in the mid-1980s, this safe, effective alternative to open cholecystectomy was quickly adopted in the United States.

Today, laparoscopic cholecystectomy is the treatment of choice for symptomatic gallstones. According to the most recent national data, more than 1,300,000 cholecystectomies for this problem are performed annually in the United States.

Clinical studies show that patients experience equivalent outcomes compared to traditional open surgery, with the added benefits of:

• Shorter hospital stay
• Faster recovery
• Less pain and scarring
• Fewer complications

With lap chole, the lengthy laparotomy is eliminated in favor of four small abdominal incisions. These accommodate the laparoscope used for visualization and the surgical instruments used to dissect and remove the gall bladder.

Because of the reduced surgical trauma, the once typical five-day hospital stay and recovery period of three to six weeks are dramatically reduced. Lap chole can often be performed as an outpatient procedure, reducing the overall cost. Patients can return to work a few days later. The complication rate is relatively low, compared to open cholecystectomy.

(Flash animation: MIP cholecystectomy versus an open procedure)

Most patients with cholelithiasis can be referred for laparoscopic cholecystectomy. Contraindications for this procedure include:

• Generalized peritonitis
• Septic shock from cholangitis
• Severe acute pancreatitis
• End-stage cirrhosis of the liver with portal hypertension
• Severe coagulopathy unresponsive to treatment
• Gall bladder cancer
• Cholecystenteric fistulas
• Pregnancy after the second trimester

As with all operative procedures, be sure to discuss surgical risks with your patients.