Laparoscopic Ultrasound and Safe Navigation Around the Shrunken Gallbladder

The contracted gallbladder may predispose to a higher rate of biliary or vasculobiliary injury (VBI). It is usually associated with unclear anatomy due to chronic inflammation and fibrosis in the hepatoduodenal ligament region. Laparoscopic ultrasound (LUS) can very effectively delineate anatomical conditions during cholecystectomy. Our study aimed to compare the visual and ultrasonographic navigation around the shrunken gallbladder. The study group consisted of 612 patients qualified for laparoscopic cholecystectomy. The shrunken gallbladder was diagnosed intraoperatively in 13 patients (2.1%). In 6 patients, the only intraoperative navigation method was a visual evaluation of anatomical conditions, and in 7 patients, the method was LUS. The operating time and the length of hospital stay after surgery were significantly lower, the number of conversions was insignificantly lower, and the number of successful visualization of anatomical conditions was significantly higher in the LUS group. We did not observe any bile duct and VBI in patients with the shrunken gallbladder. The combination of the fundus-first and subtotal cholecystectomy with LUS navigation might be an effective proposal when coming across the shrunken gallbladder.