[Difficult laparoscopic cholecystectomy]

From 2505 cases operated between 1994-2000, the authors selected a lot of 889 cases of difficult cholecystectomy, which after classical criteria would have been classified as contraindications of laparoscopic procedure. This study analyzed of intraoperative incidents, the conversion rate and particularities of operative tactics and techniques. The lot of patients includes 889 cases of difficult laparoscopic cholecystectomy. The patients were selected according to classical contraindications of laparoscopic cholecystectomy: obesity, liver cirrhosis, previous operated abdomen, severe cardio-pulmonary diseases, ages over 70 years, acute cholecistitis. The rate of intraoperative incidents and accidents was 19.9% (177 cases), in comparison to intraoperative incidents and accidents rate in "easy" laparoscopic chole-cystectomy which was 15.5% (251 cases from 1616 patients). The conversion rate in case of difficult laparoscopic cholecystectomy was 6.1% (55 patients) and 3.2% in the lot of "easy" cholecystectomy. The postoperative morbidity was 6.4% (57 patients) and 5.5% (147 patients) in the lot of "easy cholecystectomy. The postoperative mortality was 0.6% (6 deaths) and 0.3% (5 deaths) in the lot of "easy" cholecystectomy. In this paper are discussed the modalities and the technical particularities of a difficult laparoscopic cholecystectomy, able to lowering the risk of operative incidents and postoperative complications. In conclusion, laparoscopic cholecystectomy can be safely performed to the majority of patients with lithiasic cholecistitis, by an experienced surgical team.