Predictors of Difficult Cholecystectomy

Abstract Xanthogranulomatous cholecystitis is a rare variant of chronic cholecystitis characterized by severe proliferative fibrosis and accumulation of lipid-laden macrophages in regions of destructive inflammation. Xanthogranulomatous cholecystitis clinically and radiologically mimics early-stage gallbladder cancer, with wall thickening on computed tomography. The study included 14 xanthogranulomatous cholecystitis patients that were identified following retrospective analysis of the records of 1248 patients that underwent cholecystectomy between 2005 and 2011. Mean age of the 5 male and 9 female patients was 56.7 years. All 14 patients had gallbladder stones; 10 had a history of acute cholecystitis, 1 had cholangitis, and 2 presented with obstructive jaundice. A right-upper quadrant mass was palpable in 2 patients. All patients underwent cholecystectomy. Open surgery was planned and performed in 6 of the 14 patients, and laparoscopic cholecystectomy was planned in 8 patients, but was converted to open surgery in 1 case. In total, 1 patient developed wound infection, 1 patient had postoperative pneumonia, and 1 patient developed intraabdominal hematoma. None of the patients in the series died. Xanthogranulomatous cholecystitis is difficult to diagnose, both preoperatively and intraoperatively, and definitive diagnosis depends exclusively on pathological examination. Xanthogranulomatous cholecystitis should be a consideration in all difficult cholecystectomy cases.

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Laparoscopic subtotal cholecystectomy: a safe approach in difficult cholecystectomy

International Surgery Journal ◽

10.18203/2349-2902.isj20191904 ◽

2019 ◽

Vol 6 (5) ◽

pp. 1767

Author(s):

Hosni Mubarak Khan ◽

Manjunath B. G. ◽

Vasanth G. Shenoy

Keyword(s):

Bile Duct ◽

Bile Duct Injury ◽

Open Cholecystectomy ◽

Gallstone Disease ◽

Subtotal Cholecystectomy ◽

Conversion Rates ◽

Conversion To Open Cholecystectomy ◽

Difficult Cholecystectomy ◽

Symptomatic Gallstone Disease

Background: Laparoscopic cholecystectomy (LC) has been recognized as the new "gold standard" for the treatment of symptomatic gallstone disease. In order to prevent serious bile duct and vascular injuries, conversion is advocated for unclear anatomy at the Calot’s. Our aim was to assess the safety and effectiveness of laparoscopic subtotal cholecystectomy (LSC) in difficult cholecystectomy in order to reduce the incidence of bile duct injury and conversion rates.Methods: An analysis of retrospectively collected data of 452 patients who underwent LC was done at our Hospital during the period of January 2010 to December 2013. In few cases of difficult GB when Calot’s could not be dissected, laparoscopic retrograde cholecystectomy (LRC) was attempted and if that failed we adopted the technique of LSC.Results: A total of 452 patients were included. The median age was 48 years. All the 452 patients were posted for LC. Of the 452 patients, 404 patients underwent LC and the remaining 48 patients had difficult GB. Among the 48 patients having a difficult GB, 44 cases underwent LSC (3 cases underwent LSC Type-1 and 41 cases underwent LSC Type-2) and the remaining 4 cases underwent conversion to open cholecystectomy. The mean operative time was 130mins and median post op stay was 2 days.Conclusions: In our technique of LSC the conversion rates were <1% with no bile duct injury and believe that it is feasible and safe for operating on difficult GB’s.

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Papel de la proteína C reactiva y la velocidad de sedimentación globular en la predicción de colecistectomía laparoscópica dificultosa: su aplicación en un programa de residencia universitario

Revista Argentina de Cirugía ◽

10.25132/raac.v112.n2.1463.es ◽

2020 ◽

Vol 112 (2) ◽

pp. 171-177

Author(s):

Matías H. Loccisano ◽

◽

Martín Drago ◽

Hernán Todeschini ◽

Luis E. Sarotto

Keyword(s):

Laparoscopic Cholecystectomy ◽

Residency Program ◽

Surgical Planning ◽

Analytical Study ◽

University Hospital ◽

C Reactive Protein ◽

Reactive Protein ◽

Symptomatic Cholelithiasis ◽

Technical Issues ◽

Difficult Cholecystectomy

Background: laparoscopic cholecystectomy is one of the most common procedures performed in general surgery. The anatomical differences of the gallbladder and the presence of factors related to inflammation can cause technical issues during surgery. Objective: the aim of the present study was to determine the value of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as predictors of difficult cholecystectomy and to evaluate their application during presurgical planning within a university residency program. Material and methods: we conducted a retrospective and analytical study in a tertiary university hospital. A total of 104 adult patients undergoing laparoscopic cholecystectomy due to symptomatic cholelithiasis between January and July 2019 were included. The patients were categorized into two groups: difficult cholecystectomy and non-difficult cholecystectomy. Results: there were statistically significant differences in ESR and CRP values between both groups (p < 0.001). Sensitivity of ESR was 100%, specificity was 45%, with a PPV of 40% and NPV of 100%. Sen- sitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Both parameters were elevated in 14 of 16 difficult cholecystectomies and in 2 of 44 non-difficult cholecystectomies. Sensitivity of CRP was 87.5%, specificity was 86.3%, with a PPV of 70% and NPV of 95%. Conclusion: measuring ESR and CRP has proved to be a reliable method to predict difficult chole- cystectomies due to symptomatic cholelithiasis. This could be applied for surgical planning within a university residency program.

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Laparoscopic Management of Difficult Cholecystectomy

Advances in Laparoscopic Surgery ◽

10.5772/27198 ◽

2012 ◽

Author(s):

Mushtaq Chalkoo ◽

Shahnawaz Ahangar ◽

Ab Hamid ◽

Asim Laharwal ◽

Umar Younus ◽

...

Keyword(s):

Laparoscopic Management ◽

Difficult Cholecystectomy

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ASSESSMENT OF FEASIBILITY AND COMPLICATIONS OF LAPAROSCOPIC CHOLECYSTECTOMY IN CIRRHOTIC PATIENTS

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2017.v10i7.17722 ◽

2017 ◽

Vol 10 (7) ◽

pp. 272

Author(s):

Nitin Goyal ◽

Anshuman Pandey ◽

Shakeel Masood ◽

Smita Chauhan ◽

Alankar Gupta ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Average Length ◽

Bile Leak ◽

Length Of Hospital Stay ◽

Preoperative Optimization ◽

Complications Of Laparoscopic Cholecystectomy ◽

Cirrhotic Patients ◽

Difficult Cholecystectomy ◽

Open Port ◽

Additional Port

Abstract :Introduction: From the era of absolute contraindication to the phase of preferred treatment, the technique of laparoscopic cholecystectomy advances with time. Here, we report our experience of laparoscopic cholecystectomy in 20 patients of liver cirrhosis. In our institute, laparoscopic cholecystectomy is the preferred choice for cholelithiasis in cirrhotic patient.Methods: In last 2 years, 180 laparoscopic cholecystectomies were performed and 20 patients were cirrhotic. Their data analyzed retrospectively in terms of preoperative optimization, operative technique and results.Results: Laparoscopic cholecystectomy was completed successfully in 19 patients and one was converted to open. Mean operative time was 54 minutes. No additional port was required in all cases. Calot’s first dissection was performed in 18 patients and fundus first technique was used in 2 patients due to unclear anatomy. Liver bed bleeding was present in 16 patients, which was controlled effectively. Subhepatic drain was placed in 12 patients. There was no mortality. Morbidity in two patients was worsening of ascites in one; and incisional hernia in other patient which was converted to open. Port site complications were not noted in any patient and there was no evidence of intraabdominal bleeding or bile leak postoperatively. Blood and component transfusion was required in 2 patients. Average length of hospital stay was 4.8 days.Conclusion: Though laparoscopic cholecystectomy may be difficult in cirrhotic patients but it is feasible and relatively safe. It offers many advantages in cirrhotic patients and associated with low morbidity when compared with open surgery.Keywords: cirrhosis, laparoscopic cholecystectomy, difficult cholecystectomy

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Challenging situations in cholecystectomy and strategies to overcome them

European Surgery ◽

10.1007/s10353-020-00687-4 ◽

2021 ◽

Author(s):

Reinhold Függer

Keyword(s):

Laparoscopic Cholecystectomy ◽

Best Practice ◽

Clinical Symptoms ◽

Major Morbidity ◽

Early Laparoscopic Cholecystectomy ◽

Conversion To Open Surgery ◽

Delayed Cholecystectomy ◽

Difficult Cholecystectomy ◽

Underlying Diseases ◽

Bail Out

Summary Background Cholecystectomy may be difficult and hazardous, causing major morbidity and mortality. This review aims to identify situations increasing the probability of difficult gallbladders and present today’s best practice to overcome them. Methods Review of the literature and expert comment. Results One in six gallbladders is expected to be a difficult cholecystectomy. The majority can be predicted by patient history, clinical symptoms, and pre-existing comorbidities. Acute cholecystitis, mild biliary pancreatitis, prior endoscopic sphincterotomy, and liver cirrhosis are the predominant underlying diseases. Early or delayed cholecystectomy, percutaneous cholecystostomy, and pure conservative treatment are evidence-based options. Early laparoscopic cholecystectomy is of advantage in patients fit for surgery, with subtotal cholecystectomy or conversion to open surgery as bail-out strategies. The choice of the procedure depends on the experience of the surgeon. Conclusion Clinical decisions should follow a pathway based on patients’ risk, favoring laparoscopic cholecystectomy whenever possible. The implementation of an institutional pathway to deal with difficult gallbladders is recommended.

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