A 50 year old lady with history of jaundice in the past has presented with right upper quadrant abdominal pain. Examination and investigations reveal chronic calculous cholecystitis. The liver functions tests are within normal limits and on ultrasound examination the common bile ducts is not dilated. Which of the following will be the procedure of choice in her?

Okay, let's tackle this question. The patient is a 50-year-old woman with a history of jaundice. She's presenting with right upper quadrant pain, and the diagnosis is chronic calculous cholecystitis. Her liver function tests are normal, and the common bile duct isn't dilated on ultrasound. The question is about the procedure of choice.

First, I need to recall what chronic calculous cholecystitis is. It's inflammation of the gallbladder due to gallstones. The main treatment for symptomatic gallstones is cholecystectomy, which is the removal of the gallbladder. Since her liver enzymes are normal and the common bile duct isn't dilated, it suggests there's no obstruction in the bile ducts. So, no need for ERCP or other procedures to clear the ducts. The procedure of choice here would be laparoscopic cholecystectomy, which is the standard treatment for symptomatic gallstones without complications.

Now, looking at the options (though they aren't provided here), the correct answer would be the cholecystectomy. The other options might include procedures like ERCP, which is used if there's a common bile duct stone, or maybe a different approach if there's acute cholecystitis. But since this is chronic and the duct is not dilated, cholecystectomy is the way to go. I should make sure to mention why the other options are incorrect. For example, ERCP would be used if there were a CBD stone causing obstructive jaundice or cholangitis. Also, maybe options like endoscopic or open surgery could be distractors, but laparoscopic is preferred now. The clinical pearl here is that normal LFTs and no CBD dilation point towards cholecystectomy over other procedures.

**Core Concept**
Chronic calculous cholecystitis is inflammation of the gallbladder caused by gallstones, leading to recurrent biliary colic and complications like cholecystitis. The definitive treatment is **cholecystectomy**, especially when symptoms are present. Liver function tests and imaging guide management by ruling out biliary obstruction or pancreatitis.

**Why the Correct Answer is Right**
The patient has chronic calculous cholecystitis with no evidence of biliary obstruction (normal LFTs, non-dilated CBD). **Laparoscopic cholecystectomy** is the gold standard for symptomatic gallstones. It removes the gallbladder, eliminating the source of inflammation and stones. Since there’s no CBD stone or acute inflammation, no urgent intervention for the bile duct is required. This approach avoids unnecessary procedures like ERCP.

**Why Each Wrong Option is Incorrect**
**Option A:** *Endoscopic retrograde cholangiopancreatography (ERCP)* is indicated for CBD stones or cholangitis—ruled out here by normal LFTs and non-dilated CBD.
**Option B:** *Open cholecystectomy* is reserved for failed laparoscopic attempts or severe inflammation, not first-line.
**Option C:** *Percutaneous cholecystostomy* is for unstable patients with acute cholecystitis, not chronic cases.
**Option D:** *Observation* is inappropriate due to active symptoms and chronic inflammation, which increase complication risks.

**Clinical Pearl / High-Yield Fact**
**Normal LFTs

✓ Correct Answer: A. Laparoscopic cholecystectomy