There are 2 cholecystectomy approaches. The "old" approach involves a surgical extraction of the gall bladder through a trans abdominal incisions and subsequent surgical closure. This approach has the highes mortality and morbidity but is still the only approach available for the morbidly obese patient. It is a longer procedure and higher risk of complilcations. Common complications include wound infection, failure of wound closure (dehiscence), pulmonary and cardiac complications, stroke, blood clots and bleeding. The "newer" approach, (though not that new), is via transcutaneous endoscope. 3 punture wounds are made for the instruments and the gall bladder is removed by this "less invasive" approach. The same complications can occur, but with less frequency. There is less time under anesthetic and a more rapid post-operative course.
That being said: The most common factors in determining which approach is taken is OBESITY. Most surgeons will try to get an individual to lose weight prior to surgery, to improve the outcome. Other factors are CO-MORBIDITY (other complicating diseases), TOBACCO USE and past history of SURGICAL COMPLICATIONS.