scholarly journals Laparoscopic Cholecystectomy: An Initial Clinical Experience at Faridpur District

2015 ◽  
Vol 2 (2) ◽  
pp. 30-33
Author(s):  
PK Saha ◽  
Ratna Rani Roy ◽  
Nukul Sarkar ◽  
Jahangir Alam
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Symptomatic Treatment ◽  
Safe Procedure ◽  
Bladder Stones ◽  
Average Operating ◽  
Gall Bladder Stones

Background: Laparoscopic cholecystectomy quickly emerged as an alternative to open cholecystectomy. However its safety, efficacy, and morbidity have yet to be fully evaluated.Objective: The purpose of the present study was to determine the efficacy and safety of laparoscopic cholecystectomy Procedure in the removal of gall bladder stones at Faridpur district-one of the remote district of Bangladesh.Methodology: A prospective, nonrandomized, open label Consecutive study was carried out at Faridpur district using laparoscopic cholecystectomy (LC) procedure for the symptomatic treatment of Gall bladder stones. For this purpose a total number of 145 patients having conclusively diagnosed as gall bladder stones were enrolled. LC procedure was performed by North American technique-a well established and standard procedure described earlier for the purpose. The key variables studied were average operating room time, condition of the gall bladder, the presence or absence of stones, the character of stones, post-operative complicates and duration of hospital stay.Result: The study revealed that among 145 patients 83.4% were female with an average age of 40.3 years. The average operating time required was 130 minutes. Gall bladder was thickened but was free from adhesion in 96.5% cases and stones' only 3.45% patients needed open method due to fibrosis and adhesion of the gall bladder with omentum and gut. The duration of hospital or clinic stay following LC was 3.5 days. Evidence of infection like fever, pain etc. was seen only in 2.75% cases. Bleeding was present in 2.06% cases. This was corrected after blood transfusion. No injury to the common bile duct or any of the bile duct or any of the blood vessels was observed. Similarly no evidence of malignancy was seen in any of the gall bladder removed.Conclusion: The present study concludes that laparoscopic cholecystectomy is a safe, minimal invasive, cost-effective and safe procedure for the symptomatic treatment of gall bladder stones.Journal of Current and Advance Medical Research, 2015;2(2):30-33

scholarly journals GALLBLADDER CARCINOMA;

2011 ◽  
Vol 18 (01) ◽  
Author(s):  
AHMAD HASSAN KHAN ◽  
SAIFULLAH GORAYA ◽  
HAROON-UR- RASHID
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Gallbladder Carcinoma ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Chronic Cholecystitis ◽  
Surgical Department ◽  
Carcinoma Gallbladder ◽  
Average Operating ◽  
Average Operating Time

Objective: Chronic Cholecystitis is one of the commonest diseases presenting in surgical department and is subjected to cholecystectomy each time. A suspicious gall bladder on ultrasound initiates further investigations to rule out carcinoma of gall bladder yet some times a benign looking gall bladder on ultrasound turns out to be carcinoma of gall bladder on histopathology. Design: Descriptive study. Place & Duration of study: District Head Quarters Hospital, Sargodha, from September 2007 to March 2009. Patients & Methods: 200 patients who underwent both open and Laparoscopic cholecystectomy for cholelithiasis were subjected to this study. All relevant data was documented on a standardized data form. Patients were between the ages of 28-74. Patients already diagnosed as Gallbladder Carcinoma, empyema gall bladder, mucocele and gall bladder polyp were excluded from the study. Gall bladders removed after each surgery ware sent to laboratory for histopathological evaluation. Results: A total of 200 cases were studied (161 females, 39 males; M: F ratio 1:4). The mean age was 45 years (range 28-74 years). The most common presenting complaint was pain right hypochondrium with nausea and vomiting (85%).The average operating time was 50 minutes in case of open cholecystectomy and 1 hour in laparoscopic cholecystectomy. Complications included biliary leak in 2 patients (1%), Wound Infection in 3 patients (1.5%) and death in one case (0.5%). The overall rate of complications was 3%. There were a total of 5 patients of laparoscopic cholecystectomy who required extension of the incision, for Carcinoma Gallbladder. Conclusions: Carcinoma of gall bladder is a very aggressive malignancy and usually presents at a very advance stage as its symptoms mostly are marked by symptoms of cholecystitis. Detection of gall bladder carcinoma is very difficult in early stages on ultrasound. Any findings in ultrasound suggesting malignancy should be confirmed on further investigations like CT scan .Carcinoma of Gall bladder is not very common in cases of cholecystectomy for chronic Cholecystitis but once found should be dealt with extreme precision following established operating protocols. 

EVALUATION OF CLINICO-RADIOLOGICAL FACTORS PREDICTING DIFFICULT LAPAROSCOPIC CHOLECYSTECTOMY

2021 ◽  
pp. 63-66
Author(s):  
Wasif Mohammad Ali ◽  
Nazia Nanen ◽  
Atia Zaka Ur Rab ◽  
Syed Amjad Ali Rizvi ◽  
Mehtab Ahmad
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Previous History ◽  
Safe Procedure ◽  
Chi Square ◽  
Preoperative Prediction ◽  
Conversion To Open Cholecystectomy ◽  
Chi Square Test ◽  
A Prospective Study

Introduction: Laparoscopic cholecystectomy has become procedure of choice for treatment of symptomatic gallstone [1] disease . Even though it is a safe procedure occasionally it can be difcult and requires conversion to open cholecystectomy for various problems faced during surgery. Preoperative prediction of difcult laparoscopic cholecystectomy and likelihood of conversion to open cholecystectomy will avoid such complications and overall cost of treatment. Aim: To evaluate the clinico-radiological factors predicting difcult laparoscopic cholecystectomy Methods: This was a prospective study conducted from October 2018 to November 2020. Total of 101 patients meeting inclusion criteria undergoing laparoscopic cholecystectomy were included in the study. Various clinical, radiological and biochemical parameters and intraoperative difculties during surgery were recorded. The statistical analysis was done using chi-square test and ANOVA test. Results: The parameters such as sex, age, duration of disease, co-morbid disease, previous history of cholecystitis, palpable gall bladder, BMI, TLC, thickness of gall bladder, largest stone size and impacted stone are found statistically signicant in predicting difcult laparoscopic cholecystectomy and conversion to open cholecystectomy preoperatively. Conclusion: Difcult laparoscopic cholecystectomy may be predicted preoperatively even with a good clinical judgement whereas both clinical and radiological parameters provide a better preoperative prediction of difcult cholecystectomy so that the surgeon can prepared in advance for the complications.

scholarly journals SURGICAL AUDIT - LAPAROSCOPIC CHOLECYSTECTOMY IN A FREE CAMP AT PRIVATE SECTOR HOSPITAL

2020 ◽  
Vol 11 (2) ◽  
pp. 16-20
Author(s):  
Dr. Abdul Ghani Soomro
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Hospital Stay ◽  
Open Cholecystectomy ◽  
Port Site ◽  
Bladder Injury ◽  
Safe Procedure ◽  
Trocar Site ◽  
Port Site Hernia ◽  
Surgical Audit

BACKGROUND & OBJECTIVE: Laparoscopic Cholecystectomy is usual method for the treatment of gall bladder stone disease and is practiced all over the world due to many benefits like fasten the recovery time. Furthermore, it reduced the post-operative pain and period of hospital stay. To conduct Surgical Audit and evaluate safety of Laparoscopic cholecystectomy. METHODOLGY: This prospective study was conducted in a private hospital at Hyderabad during free camps of Laparoscopic Cholecystectomy. Four camps were arranged in 2016 - 2019. Total number of 190 patients  underwent Laparoscopic Cholecystectomy during the study period. The patient's age falls between 12–65 years. A detailed history, relevant investigation and Cardiac fitness were evaluated. All patients underwent four ports Lap-Chole. Data was collected assessed and audit was performed and safety was evaluated. RESULTS: Total 190 patients operated females 88.45% and males 11.55%. 115 (60.50%)were in  the range of 30-35 years followed by 55 (28.95%)patients in the range of 40-50 years.8 (4.20%) patients were converted to open cholecystectomy, 4 due to bleeding from liver bed, 3 patients due to difficult dissection in calots triangle and 1 due to Empyema of gall bladder.10 patients (5.50%) had Trocar site bleeding, 10 patients (5.50%) had gall bladder injury, in 4 cases had spillage of stones and 72 patients (38.50%) developed umbilical port site infection 1 patient develop port site hernia. No mortality was recorded in this study. CONCLUSION: Our Surgical Audit proves that Laparoscopic Cholecystectomy is a safe procedure on the basis of only 4.2% intra operative and 5.5% postoperative complications and gaining wide spread popularity among our population due to less pain, less hospital stay. We recommend other private hospitals to extent such services to our poor population with symptomatic cholelithiasis.

scholarly journals Conversion Rate from Laparoscopic to open Cholecystectomy in AL-kindy Teaching Hospital, Baghdad

2020 ◽  
Vol 15 (2) ◽  
pp. 76-81
Author(s):  
Firas M Rashid
Keyword(s):  
Risk Factors ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Gall Bladder ◽  
Gall Bladder Disease ◽  
Bile Duct Stone ◽  
Open Cholecystectomy ◽  
Bladder Disease ◽  
Common Causes ◽  
History Of

Background: laparoscopic cholecystectomy (LC) is getting popularity for the treating of symptomatic gall bladder disease; conversion from laparoscopic to open cholecystectomy (OC) is also common. Objective : To find out the prevalence of causes, risk factors of conversion from LC to OC among  patient suffering from gall bladder disease, and  to explore the most common causes of conversion from laparoscopic to open cholecystectomy. Methods: This prospective study was conducted in the department of general surgery at Alkindy teaching hospital from first of January 2016 to the end of December 2017 .Nine hundred twenty patient were included. Patient age, gender, history of previous abdominal scar, common bile duct stone, ERCP, duration of symptom was included in our study. Results: Seven hundreds twenty –seven patients 74.48% were females and 191  26.52% were males. The mean age of patient presented with gall bladder disease was 40.43 years. Thirty –eight patients were converted to open cholecystectomy. The most common cause of conversation was dense adhesions 42.1% - followed by bleeding 30.1%. Other common causes of conversion were biliary anomalous anatomy 10.5%, common bile injury 5%, visceral injury and technical failure  7%. Conclusion: The main perioperative cause for OC was dense adhesion around gall bladder and the male gender, increasing age, history of common bile duct stone removed by previous ERCP, history of previous surgery, are independent risk factors of difficult laparoscopic cholecystectomy.  

scholarly journals Complications of Two Port Laparoscopic Cholecystectomy-Studyof 50 Cases

2019 ◽  
Vol 31 (1) ◽  
pp. 29-37
Author(s):  
Nasir Uddin Mahmud ◽  
Ghyas Uddin ◽  
Md Anwarul Haque ◽  
ANM Mozammel Haque ◽  
AKM Golam Kibria
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Gall Bladder ◽  
Open Cholecystectomy ◽  
Gallstone Disease ◽  
Bile Leakage ◽  
Safe Procedure ◽  
Minimal Scarring ◽  
Conversion To Open Cholecystectomy ◽  
Port Infection ◽  
Good Cosmesis

Background: For the management of Gallstone disease, laparoscopic cholecystectomy has been the the gold standard and is preferred over open cholecystectomy. As patients’ demand has increased for improved postoperative quality of life and cosmesis, surgeons have continued to decrease the number of ports for laparoscopic cholecystectomy. To meet these expectations we adopted two-port techniques at Comilla, Bangladesh. For the last three years we have selected 50 patients where two-port laparoscopic cholecystectomy was trialled. The procedure were successfully performed in 47(94%) & conversion were required in 3(6%) with some accepted complications like epigastric port infection & herniation, post cholecystectomy syndrome, reactionary haemorrhage, bile leakage & biloma, significant epigastric port pain postoperatively & stricture of CBD. The present two port technique not only overcoming specimen extraction difficulties but also contributes to good cosmesis. Objectives: To see the outcome of two port laparoscopic cholecystectomy. Methods: Consecutive 50 patients were admitted in surgery ward of Central medical college, Comilla with gallstone disease over a 3 years period. Diagnosis is confirmed by ultrasound with the assessment of operative feasibility. Data collection sheet was maintained by Microsoft Excel. Data were analyzed manually. Results: In this study 50 patients were included. Among them 34 (68%) were females and 16 (32%) were males (ratio = 2.1:1). Mean age was 35.7 years (range 20–55years).All patient were undergone two port laparoscopic cholecystectomy & successfully accomplished in 47 (94%),conversion were required in 3 (6%) patients. Most common (62%) sonological findings were cholelithiasis with normal size & shape of gall bladder. Mean operative time was 50 minutes. Among the per operative difficulties bleeding were 14%, perforation of gall bladder 10%, spillage of gallstones 6%, epigastric forceps manipulation difficulties 4%,conversion to open cholecystectomy 6%. Most of the patients(80%) admitted in hospital for 2-3 days. 4 (8%) patient had epigastric port infection & 1 (2%) patient developed this site herniation, 3 (6%) patient had post cholecystectomy syndrome,1 (2%) patient had reactionary haemorrhage, 1 (2%) bile leakage & biloma,4(8%) patient had significant epigastric port pain postoperatively, 1 (2%) patient developed delayed stricture of CBD. In all other patients wound healed nicely with minimal scarring, with very less postoperative pain, with no problem so far in 3 years follow up. Most patients (90%) returned to work within 2 weeks. Conclusion: Two-port laparoscopic cholecystectomy is a safe procedure & cosmetically rewarding. TAJ 2018; 31(1): 29-37

scholarly journals Determinants of conversion during laparoscopic cholecystectomy among a sample of Iraqi patients

2018 ◽  
Vol 5 (7) ◽  
pp. 2455
Author(s):  
Abutalib B. Alluaibi ◽  
Bahaa K. Hassan ◽  
Alaa H. Ali ◽  
Ahmed A. Muhsen
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Gall Bladder ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Male Gender ◽  
Visceral Injury ◽  
Previous Abdominal Surgery ◽  
Calot’S Triangle ◽  
Conversion To Open Cholecystectomy

Background: Laparoscopic cholecystectomy has become a standard technique for gall bladder surgery of symptomatic cholelithiasis. However, conversion to open cholecystectomy is sometimes necessary. The aim of the present study was to assess the predictive factors that increase the possibility of conversion of laparoscopic cholecystectomy to open cholecystectomy.Methods: A total of 621 laparoscopic cholecystectomies were attempted at AL-Mawanee General Hospital and AL-Sader Teaching Hospital in Basrah, IRAQ from June 2012 till June 2016.Of these,43 had to be converted to open cholecystectomies. Patients assessed according to different factors, including age, sex, acute cholecystitis, adhesions of gallbladder and calot's triangle, obesity, previous abdominal surgery, anatomical variation of gallbladder and Calot's triangle and intraoperative complications (bleeding, bile duct injury, visceral injury).Results: Conversion to open cholecystectomy was performed in 43 patients (6.92%). The significant factors for conversions were adhesions of gallbladder and Calot's triangle(39.53%) followed by acute cholecystitis(34.88%). Rate of conversion in other factors are as the following i.e., isolated male gender (0%), age (0%), previous abdominal surgery (9.3%), obesity (2.33%), anatomical variations of gall bladder and calot's triangle (2.33%), intra operative complications including bleeding (4.65%), bile duct injury (4.65%), visceral injury (2.33%) were insignificant factors for conversion.Conclusions: Adhesions of gallbladder and calot's triangle is the most common predictive factor and cause for conversion from laparoscopic cholecystectomy to open cholecystectomy. Acute cholecystitis found to be the strongest factor for conversion despite its incidence is lower than adhesions of gall bladder and calots triangle. Male gender and age more than fifty years are not direct predictive factors for conversions.

scholarly journals Factors influencing conversion of laparoscopic cholecystectomy into open cholecystectomy

2019 ◽  
Vol 6 (11) ◽  
pp. 4017
Author(s):  
Ankur Dutt Tripathi ◽  
Imran Qazi ◽  
Shashank Shekhar Tripathi
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Gall Bladder ◽  
Epigastric Pain ◽  
Open Cholecystectomy ◽  
Univariate Analysis ◽  
Bladder Injury ◽  
Stone Size ◽  
Increased Risk

Background: Laparoscopic cholecystectomy may be rendered difficult by various problems encountered during surgery, such as difficulty in accessing the peritoneal cavity, creating a pneumoperitonium, dissecting the gall bladder, pericholecystic adhesions and adhesions between the common bile duct the cystic duct and the cystic artery (calot’s triangle) or extracting the excised gall bladder, injury to common bile duct, bowel and iliac vessels. These conditions may lead surgeons to perform conventional open cholecystectomy.Methods: The general biodata was collected. A detailed history was taken with special reference to duration of right upper quadrant pain or epigastric pain, its periodicity, its aggravation by fatty meals and relief by oral or parental analgesics. Fever, jaundice or any previous attacks of cholecystitis. A relevant general physical examination and systemic examination was done and findings recorded, routine laboratory investigation was done. All cases were then subjected to ultrasound examination with 2-5MHz curvilinear array transducer with an aim to assess.Results: The univariate analysis sex proved to be significantly predictive of conversion in the present study. Execution of ERCP before the intervention proved associated with an increased risk for conversion in our study. Stone position as significant factor for conversion while stone size was not significant. No significant association between fever and conversion our study.Conclusions: Male gender, GB wall thickness, stone position, stone size, ultrasound signs of pericholecystitis, acute cholecystitis, were significantly associated with conversion.

SP6.1.8Fundus-first laparoscopic cholecystectomy for complex gallbladders: A systematic review

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Michael El Boghdady ◽  
Hossein Arang
Keyword(s):  
Systematic Review ◽  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Bile Duct Injury ◽  
Scientific Evidence ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Research Quality ◽  
Cochrane Library ◽  
Conversion To Open Cholecystectomy

Abstract Aims Retrograde ‘fundus-first’ cholecystectomy is when the dissection starts from the fundus of the gallbladder to the infundibulum, in case structures of Calot's triangle cannot be identified. Although feasible in laparoscopic cholecystectomy, it remains an underutilized approach. We aimed to systematically review the fundus-first laparoscopic cholecystectomy and study its safety and feasibility. Methods A systematic review was performed in compliance with PRISMA guidelines. A literature search was performed using PubMed/MEDLINE, ScienceDirect and Cochrane-Library for articles published from 2010 to 2020. Search keywords included ‘retrograde cholecystectomy’, ‘fundus-first cholecystectomy’ and ‘fundus-down cholecystectomy’. Quality assessments were applied using the Medical Education Research Quality Instrument (MERSQI) score. The protocol was registered with PROSPERO register. Results A total of 3503 studies formed the base for evidence evaluations. 12 studies with 1978 fundus-first cholecystectomies were assessed. Three citations were scored high and 5 moderate quality. Endpoints included blood loss, rate of conversion to open, bile duct injury, gallbladders perforations, postoperative pain and hospital stay. Nine studies provided both strong and moderate scientific evidence for a positive outcome of the fundus-first approach. Conclusion The fundus-first cholecystectomy was associated with a reduced need for intraoperative cholangiography, shorter operating time, lower incidence of intra-operative complications, bile duct injury and reduced incidence of conversion to open cholecystectomy.

scholarly journals Gallstones in Elderly Patients: Impact of Laparoscopic Cholecystectomy

2000 ◽  
Vol 14 (11) ◽  
pp. 929-932 ◽  
Author(s):  
A Montori ◽  
M Boscaini ◽  
M Gasparrini ◽  
G Miscusi ◽  
L Masoni ◽  
...  
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Bile Duct ◽  
Common Bile Duct ◽  
Elderly Patients ◽  
Acute Cholecystitis ◽  
Open Cholecystectomy ◽  
Common Bile Duct Stones ◽  
Safe Procedure ◽  
Bile Duct Stones ◽  
Class Iii

The use of laparoscopic cholecystectomy (LC) in elderly patients may pose problems because of their poor general condition, especially of cardiopulmonary function. Moreover, these patients present with acute cholecystitis and associated common bile duct stones more often than their younger counterparts. From 1990 to 1999, the authors performed 943 LCs; 31 (3.2%) were attempted on elderly patients, 11 (35%) of which were on an emergency basis because of acute cholecystitis, cholangitis or acute biliary pancreatitis. Ten per cent of LCs needed to be converted to an open cholecystectomy, most often because of an increase in the partial pressure of carbon dioxide in the blood produced by excessive operative time. A gasless procedure was used in the last three years of the study on eight cases; the overall rate of conversion from LC to open cholecystectomy in this group was 0%. Associated gallbladder and common bile duct stones were found in five (16%) patients (four preoperative LC endoscopic sphincterotomy and one transcystic approach). The success rate in both of these cases was 100%, overall morbidity was 29% and there was no mortality. These results show that LC is a feasible and safe procedure for use in elderly patients. Gasless LC should be preferred in patients classified as American Society of Anesthesiologists’ class III because an excessive duration of operation is the most common reason for converting to an open cholecystectomy.

scholarly journals Laparoscopic Cholecystectomy- A Safe treatment option for Gangrenous Cholecystitis 48 and Empyema Gallbladder in experienced hands

2019 ◽  
Vol 19 (2) ◽  
pp. 48-51
Author(s):  
Samiron Kumar Mondal ◽  
Sharmistha Roy
Keyword(s):  
Laparoscopic Cholecystectomy ◽  
Open Cholecystectomy ◽  
Operating Time ◽  
Laparoscopic Procedure ◽  
Safe Procedure ◽  
Intracorporeal Suturing ◽  
Gangrenous Cholecystitis ◽  
Number Of Patients ◽  
Conversion To Open Cholecystectomy ◽  
Operative Recovery

Background: Laparoscopic cholecystectomy has become the gold standard of treatment for gall stone disease and in acute cholecystitis. But controversy persists regarding laparoscopic approach to gangrenous gallbladder and empyema gallbladder due to the risk of life threatening complications. We share our experience in a tertiary care multidisciplinary diabetic hospital where we encounter significant number of patients with empyema Gallbladder and gangrenous gallbladder because most of our patients are diabetic and hence immunocompromised. Purpose of this study was to evaluate the safety of laparoscopic procedure for the treatment of empyema of gallbladder and gangrenous gallbladder in an experienced hand. Methods & Materials: Between January 2013 and January 2015 we performed 1191 cases of laparoscopic cholecystectomy. Empyema gallbladder and gangrenous gallbladder were found per operatively in 345 and 53 cases respectively.All were managed by laparoscopic procedure except two cases, where conversion to open cholecystectomy was needed. Result: The mean operating time was 72 minutes(45-100 minutes) in empyema gallbladder. In gangrenous cholecystitismean operating time was 80 minutes(60-100 minutes). Total number of patients (including empyema gallbladder 345 and gangrenous cholecystitis 53) were 398. Among them 52 patients (13%) had excessive bleeding(>100ml) from calot’s triangle or gallbladder bed in liver. Spillage of stones occurred in 28 patients (7%). 1 patient had common bile duct injury (.25%). Gallbladder retrieval was difficult in 71 patients (18%). In the post operative period 21 patient (5%) developed minor port infection in the umbilical port. 9 patients (2%) developed chest infection, and 1 patient (.25%) developed MI. 356 patients (89%) were discharged within 72 hours of surgery. Conclusions: Innovative technique, appropriate instruments, knowledge about the possible risks and way to manage them, with expertise in intracorporeal suturing and knotting are an essential pre requisites to attempt these cases. Operating time is more but post operative recovery is prompt. Hospital stay is significantly less than open cholecystectomy. Laparoscopic cholecystectomy is a safe procedure in cases of Empyema and gangrenous gallbladder, provided the surgeon is experienced enough and has a low threshold to convert to open cholecystectomy at anypoint of time. Journal of Surgical Sciences (2015) Vol. 19 (2) : 48-51

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