Synopsis
Match laparoscopic cholecystectomy to the gallstone syndrome and evidence-based timing, prepare the patient safely, and recognise when difficult anatomy requires a bailout or specialist plan.
- Offer laparoscopic cholecystectomy for symptomatic gallbladder stones and for acute cholecystitis within one week of diagnosis when suitable.
- Offer bile-duct clearance and laparoscopic cholecystectomy to people with common-duct stones, even when the duct stones are asymptomatic.
- Do not routinely remove a normal asymptomatic gallbladder solely because stones were incidentally detected.
Key red flags
Unexpected ductal anatomy, uncontrolled bleeding or inability to identify safe structures requires immediate senior surgical judgement.
After surgery, tachycardia, abdominal pain, fever, jaundice or bilious drainage may indicate bile leak or duct injury and needs urgent assessment.
Dense inflammation, bleeding or variant ducts make uncertain clipping an immediate injury risk and justify a bailout.
Reasoning priorities
Confirm stones and assess common-duct probability before surgery.
Gallbladder stones support the indication; abnormal liver tests or duct dilatation may require MRCP, EUS or an agreed clearance strategy.
Worked reasoning
A fit 46-year-old is diagnosed on Monday with 20 hours of right-upper-quadrant pain, temperature 38.1°C and ultrasound-confirmed gallbladder wall thickening around an impacted neck stone; liver tests show no common-duct pattern.
- Confirm anaesthetic fitness, venous-thromboembolism and bleeding plans, and low common-duct-stone probability after reviewing the ultrasound and liver-test pattern.
- Offer laparoscopic cholecystectomy during the same admission and book it for Wednesday, two days after diagnosis and within the NICE one-week standard.
- At operation, obtain all three critical-view-of-safety components before division of the cystic duct and artery; the inflamed gallbladder is removed laparoscopically without bile leak or conversion.
- Verify the observed recovery: the patient is afebrile, tolerating food and mobilising the following morning, with stable haemoglobin and no jaundice, and is discharged with pathology follow-up and return advice.