Selective preoperative assessment before early laparoscopic cholecystectomy: A narrative review

Abstract

Early laparoscopic cholecystectomy is recommended for symptomatic gallstone disease, acute cholecystitis and mild gallstone pancreatitis because it reduces recurrent biliary events and avoidable readmission. Formal preoperative assessment remains essential when comorbidity, frailty, medication complexity or anaesthetic concerns require investigation or optimization. Whether every low-risk patient needs a separate clinic-based appointment before early surgery is less certain. This narrative evaluates the evidence relevant to selective preoperative assessment, drawing on guidelines, routine-testing studies, perioperative risk literature and an illustrative five-year United Kingdom Hot Gallbladder Pathway service evaluation involving 511 patients. Current guidance supports individualized investigation but does not define criteria for omitting preassessment. Indirect evidence suggests that structured screening, review of recent clinical information and same-day anaesthetic confirmation may provide a feasible pathway for carefully selected American Society of Anesthesiologists I-II patients without red flags. The United Kingdom service evaluation reported no identified anaesthetic-related adverse event and one non-anaesthetic cancellation, but its retrospective single-trust design cannot establish equivalence, rare-event safety or cost-effectiveness. Selective assessment should therefore be regarded as a governed service model rather than an established standard. Prospective multicentre studies should compare cancellation, perioperative complications, unplanned admission, time to surgery, patient experience, resource use and cost-effectiveness.

Keywords: Laparoscopic cholecystectomy; Preoperative assessment; Anaesthetic assessment; American Society of Anesthesiologists classification; Risk stratification; Perioperative medicine; Hot Gallbladder Pathway; Narrative review

Core Tip: Preoperative assessment is a clinical function. For early laparoscopic cholecystectomy, selected low-risk patients may be suitable for structured screening and same-day anaesthetic confirmation, while patients with American Society of Anesthesiologists III-IV status, frailty, unstable disease, complex medication needs or anaesthetic concerns require formal optimisation. The supporting evidence is mainly indirect. A 511-patient United Kingdom service evaluation demonstrates feasibility but cannot establish safety equivalence or cost-effectiveness. Selective assessment should therefore be introduced only with explicit criteria, anaesthetic governance and prospective audit.