Hey and thanks for qyestion. Cholecystektomi is major surgery. Mainly because it is very common worldwide, even severe complications can occur why it have to be up to 100% professional surgery every time. Some have severe inflammation and cancer, common duct injuries affect Life time. Simulation helps to make safe surgeons. Best regards Stefan Redéen

Cholecystectomy has always been considered a minor operation even in the pre laparoscopic era, but even then the complications due to bleeding or injury to the bile duct were not uncommon. In laparoscopic era things had not changed much, plus you may have associated the complications of the laparoscopic technique. In spite of a low-grade DRG , open or laparoscopic cholecystectomy, can be a huge problem that can lead to do an hepatectomy, in the case of complex lesions. In addition, the percentage of complications that you can read from the literature, are certainly underestimated

LapChole per se is clearly not major operation. Complicated LapChole may require major surgery for control of complications but this does not change the fact that LapChole is one of the simplest abdominal operations.

Surgical practice

Types of operations

Surgical operations are generally classified by both surgeons and anaesthetists according to a scale of magnitude which is also related to the risks and the degree of physiological disturbance (Lafferty K, Rennie J (eds.), 1998) :

minor operation - e.g. skin lesion removal,

intermediate - e.g. inguinal hernia repair,

major - e.g. cholecystectomy,

complex major - e.g. hemicolectomy with anastomosis,

complex major plus - e.g. open heart surgery.

nother classification is associated with the degree of urgency (Lafferty K, Rennie J (eds.), 1998) , (Smeltzer SC, Bare BG (eds), 2003) :

emergency - unplanned, immediate surgical intervention (usually within 1 hour) or resuscitation simultaneous with surgery, e.g. severe trauma, a ruptured ectopic pregnancy, pericardiocentesis for cardiac tamponade,

urgent - an operation which has to be done quickly, as soon as possible after resuscitation, usually within 24 hours; e.g. peritonitis,

required – the patient needs to have surgery, but an operation can be planned within a few weeks or months; e.g. benign prostatic hyperplasia without bladder obstruction, eye cataract,

scheduled (or elective) - a surgical procedure that is a matter of choice; planned and performed at time to suit both patient and surgeon as it is not urgently needed; e.g. ambulatory surgical procedures, like simple hernia repair, varicose veins, etc.

optional – when a decision rests with patient, and it is based on his/her personal preference; e.g. plastic or cosmetic surgery.

Working on assumption, that most Major operations are relatively long procedures and

will require a minimum of three nurses in the operating room and minor operations are of

shorter duration and will require a maximum of three nurses in the operating room there are

several valid reasons for classifying operation into Major and Minor.

Bupa (British United Provident Association) Schedule of Procedures

www.bupa.co.uk/codes

First e

dition published in 1989 by The British United Provident Association Limited.

Second edition published in 1992 by The British United Provident Association Limited.

Procedures are classified into the following 25 categories:

Minor - 1 / 2/3/4/5

Inter --1/2 /3/4/5.

Major --1/2/3/4/5

CMO-- 1/2/3/4/5.

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SURGICAL CATEGORIES

Category 1- Minimal risk, minimal blood loss (ie, minor outpatient procedure

Category 2 - Mild risk, blood loss 1500 cc (eg, major spinal surgery, GI, GU and vascular surgery)

Category 5 - Critical risk, blood loss > 1500 cc (eg, cardiothoracic, intracranial, radical procedures)

Thanks Ananath,

Thanks for the question.

Lap Chole is a very common surgical procedure these days which is replacing open cholecystectomy in the past. Now and before surgeons consider it one of these operations which most of the time go straightforward and suitable for training and improving surgical skills. On the other hand Lap chole may has serious consequences. Most probably it is in between i.e intermediate operation. Definitely it is not lipoma excision or even inguinal hernia repair.

Regards

Dear Reddy

There is no minor operation. The little things may go wrong

Regards

Laparoscopic Cholecystectomy is not a minor surgery. It is intermediate because it has some complicated complications. Cholecystectomy for cholecystitis is major surgery

There is not any minor operation in the peritoneal cavity. The lap Chol can be named as intermediate procedure but with major complications.

In the modern era of economy and marketing everything is possible to say.

But if we start to talk and declare any procedure in surgery as minor then the financial constructions considering surgery will change in unfortunately inappropriate way.

Any intra-abdominal surgery is potentially deadly and we should treat it that way. The other topic is whether surgeons today are experienced to make it with extremely little complications and with fast recovery. That is why patients today take these operations as granted. But operations are potentially deadly and we should remember that.

Cars are significantly safer with significantly less fuel consumption than 20 years before. But cars cost twice as were 20-30 years ago !!

There is not any minor procedure in peritoneal cavity . Lap. chol . can be named as intermediate operation .

Sir, I would think it is a major surgery - given all the potential risks of the procedure

From the ethical point of view every surgical intervention presents a major surgical responsibility. That mean each operation can be considered a great challenge nevertheless the surgical access - mini or maxi …

Very interesting question, with a difficult answer. I totally agree with you, with the term "biliary cripple". Indeed, quality of life in these unfortunate patients could be ruined in the long term.

However, characterising a procedure as minor or major is the resultant of many factors. One should take into consideration not only an isolated case (or cases) of complications. Patients may die even after the most "simple" operations like hernioplasty. This does not necessarily mean that hernioplasty is a major operation. It is frequently performed by first-year residents, under local anesthesia and a day-case protocol. The days of Bassini are long gone... I mean, of course, that every procedure has to be performed in the best possible and responsible way. From that point of view, every time our scalpels touch a patient, it is a major challenge. 

However, taking into consideration the morbidity rate, the mortality rate, the complication rate, and stratifying the overall risk, then I would say that lap. cholecystectomy is an intermediate procedure. 

Insurance companies have classified surgical interventions in categories. I have found the BUPA Schedule of procedures on the internet. You may have a look there. Just for a general idea:

Skin biopsy is minor

Hernia repair is intermediate

Lap. Chole is major

Right hemicolectomy is major+

Pancreatectomy is complex

Dr Dimitrios,Thankyou

I think Lap chole is intermadiate operation.  Surgeon must be aware of potantial complications. 

Good evening, I think it’s a major surgery - known the potential risks of the procedure

"There is no entity as minor surgery, only minor surgeons"

My mentor keeps telling.

When everything goes smooth with good patient recovery, Supra major may look like a minor surgery. When things go wrong , even a simple procedure appears very major. WE have to be equally cautious in all surgeries.