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cholecystectomy
The indication for cholecystectomy is usually right upper quadrant abdominal pain that has been persistent for weeks to months.
      
Although cholecystectomy will result in pain relief in many patients, the presence of coexisting HIV cholangiopathy in about half these patients increases the likelihood of ongoing symptoms.
      
In patients without biliary fistula (Mirizzi type I), simple cholecystectomy suffices to relieve the bile duct obstruction.
      
Patients with an abnormal gallbladder ejection fraction should undergo cholecystectomy.
      
Before discharge, patients should undergo cholecystectomy, or if they are unfit for surgery, endoscopic sphincterotomy and bile duct clearance.
      
Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis.
      
Combined cholecystectomy with Roux-en-Y gastric bypass surgery is a safe and appropriate therapeutic option in those with preoperatively known gallstones, biliary sludge, and prior episodes of cholecystitis.
      
However, routine cholecystectomy at the time of gastric bypass surgery is not warranted for all patients because of the increased time of operation and postoperative hospitalization, as well as all the potential complications after cholecystectomy.
      
The approach of routine cholecystectomy in this setting subjects many patients to an unnecessary procedure because the majority will not develop symptoms or complications of gallstones.
      
Furthermore, cholecystectomy is technically easier to perform after weight loss occurs.
      
In patients who develop biliary-type pain, cholecystitis, cholangitis, or pancreatitis, the treatment of choice is cholecystectomy for those who can tolerate surgery.
      
Cholecystectomy is recommended to treat acalculous cholecystitis, and celiac plexus block may be offered to patients with terminal disease and intractable abdominal pain.
      
Given the high mortality of untreated disease, definitive treatment consists of cholecystectomy or, in poor surgical candidates, cholecystostomy.
      
In the asymptomatic patient, gallbladder polyps that are greater than 1 cm in diameter should be treated with cholecystectomy.
      
If the physician is confident that the polyps are the source of thepain, patients should be referred for cholecystectomy.
      
Laparoscopic cholecystectomy is the treatment of choice for most gallbladder polyps.
      
If a malignant polyp is suspected, patients should undergo an open cholecystectomy.
      
A small but increasing proportion of cases of incidental GBC detected during or after cholecystectomy is also being seen.
      
Such patients are generally in an earlier stage of disease and are potentially more curable by a completion radical cholecystectomy, which is especially indicated for patients whose disease is stage pT1b or beyond.
      
When feasible, extended or radical cholecystectomy is the standard treatment for resectable GBC.
      
 

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