Contraindications to laparoscopic cholecystectomy:
(1) generalized peritonitis
(2) cholangitis with septic shock
(3) severe acute pancreatitis
(4) end stage cirrhosis with portal hypertension
(5) severe coagulopathy unresponsive to treatment
(6) known carcinoma of the gallbladder
(7) cholecysto-enteric fistulas
(8) third trimester of pregnancy
Situations requiring special expertise:
(1) acute cholecystitis
(2) acute gallstone pancreatitis that has subsided
(3) prior surgery in the upper abdomen
(4) second trimester of pregnancy
(5) persons with chronic obstructive pulmonary disease (possible problems due to hypercarbia or acidosis caused by carbon dioxide)
Controversial:
(1) first trimester of pregnancy (unknown effect of carbon dioxide on fetus)
(2) severe obesity
(3) choledocholithiasis
