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Case Report: Modified Laparoscopic Subtotal Cholecystectomy: An Alternative Approach to the "Difficult Gallbladder"
Michael S Segal1, Richard H Huynh1, George O Wright1
1Department of Surgery, Wyckoff Heights Medical Center, Brooklyn, NY, USA.
The American Journal of Case Reports
|February 22, 2017
Summary
Laparoscopic subtotal cholecystectomy (LSC) offers a safe alternative to open surgery when visualizing the Callot triangle is difficult during laparoscopic cholecystectomy. This approach minimizes the risk of common bile duct injury in complex cases.
Area of Science:
- Surgical Innovation
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Laparoscopic cholecystectomy is a standard procedure.
- Difficult visualization of the Callot triangle can occur due to inflammation or adhesions.
- Failure to achieve the critical view of safety (CVS) increases the risk of bile duct injury.
Observation:
- A 56-year-old male with acute cholecystitis presented with a "difficult gallbladder."
- Poor visualization of the Callot triangle precluded safe dissection.
- Dissection commenced at the gallbladder dome to ensure safety.
Findings:
- Laparoscopic subtotal cholecystectomy (LSC) was successfully performed.
- This approach provided an alternative view, avoiding common bile duct (CBD) injury.
- LSC served as a viable alternative to conversion to open cholecystectomy (OC).
Implications:
- LSC is a potentially valuable technique for managing difficult gallbladders.
- It offers a safer alternative to conversion to OC in specific scenarios.
- Surgeons must weigh the benefits and risks of LSC versus OC conversion.
