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  • Gallbladder and Gallstone Related Disease

    Cholecystitis

    The fellow should be able to:

    • Demonstrate an understanding of the management of the patient with acute cholecystitis
    • Demonstrate the difference in management of acute calculous and acalculous disease
    • Demonstrate an understanding of the imaging options for the evaluation of cholecystitis and the limitations of each modality
    • Demonstrate an understanding of the role of medical management in cholecystitis
    • Understand the roles of and controversies surrounding the use of non-surgical techniques for management of cholecystitis including percutaneous cholecystostomy and endoscopic decompression
    • Describe the surgical treatment options for cholecystitis including open and minimally invasive techniques
    • Describe the management of a common bile duct injury
    • Describe the options for management of the difficult gallbladder including the role of subtotal cholecystectomy
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    Choledocholithiasis

    The fellow should be able to:

    • Demonstrate an understanding of the etiology and management of choledocholithiasis
    • Describe the preoperative evaluation for choledocholithiasis as related to risk factors for choledocholithiasis
    • Describe the indications/limitations of preoperative MRCP and ERCP
    • Describe the indications for and technique of performing intra-operative cholangiogram
    • Describe the indications and contra-indications for laparoscopic common bile duct exploration
    • Describe the techniques for open and laparoscopic CDB exploration
    • Recognize the controversy of preoperative stone clearance vs “surgery first” strategy
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    Ascending Cholangitis

    The fellow should be able to:

    • Demonstrate an understanding of the etiology and pathophysiology of ascending cholangitis
    • Describe the severity grading system for ascending cholangitis
    • Describe the medical management of ascending cholangitis
    • Describe the techniques for treatment of cholangitis including indication for surgical options
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    Resources

    • Topic Summary
    • AAST Education Module - Complicated Cholecystitis and Choledochlithiasis
    • Meet the Mentors - Cholecystectomy: Do No Harm
    • March 2024 Journal Club - Difficult Gallbladders
    • Overview Article:
      • Gallaher JR, Charles A. Acute Cholecystitis: A Review. JAMA. 2022;327(10):965-975. doi:10.1001/jama.2022.2350
    • Additional Resources:
      • Bosley ME, Nunn AM, Westcott CJ, Neff LP. Antegrade balloon sphincteroplasty as an adjunct to laparoscopic common bile duct exploration for the acute care surgeon. J Trauma Acute Care Surg. 2022;92(3):e47-e51.
      • Loozen CS, van Santvoort HC, van Duijvendijk P, et al. Laparoscopic cholecystectomy versus percutaneous catheter drainage for acute cholecystitis in high risk patients (CHOCOLATE): multicentre randomised clinical trial. BMJ. 2018;363:k3965. Published 2018 Oct 8. doi:10.1136/bmj.k3965
      • Navaratne L, Martinez Isla A. Transductal versus transcystic laparoscopic common bile duct exploration: an institutional review of over four hundred cases. Surg Endosc. 2021;35(1):437-448. doi:10.1007/s00464-020-07522-7
      • Okamoto K, Suzuki K, Takada T, et al. Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis [published correction appears in J Hepatobiliary Pancreat Sci. 2019 Nov;26(11):534]. J Hepatobiliary Pancreat Sci. 2018;25(1):55-72. doi:10.1002/jhbp.516
      • van Dijk AH, Donkervoort SC, Lameris W, et al. Short- and Long-Term Outcomes after a Reconstituting and Fenestrating Subtotal Cholecystectomy. J Am Coll Surg. 2017;225(3):371-379. doi:10.1016/j.jamcollsurg.2017.05.016
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