Laparoscopic bailout surgery effective procedure for patients with difficult laparoscopic cholecystectomy

Area of Science:

• Surgical Innovation
• Gastroenterology
• Minimally Invasive Surgery

Background:

• Bailout surgery (BOS) is recommended for complex laparoscopic cholecystectomies.
• Clear criteria for choosing between laparoscopic and open BOS are lacking.
• Optimal management of the remnant cystic bile duct requires further investigation.

Purpose of the Study:

• To compare outcomes of laparoscopic versus open BOS.
• To evaluate different methods for managing the remnant cystic bile duct.
• To identify factors influencing the choice of BOS approach and duct management.

Main Methods:

• Retrospective analysis of 57 patients undergoing BOS.
• Comparison of laparoscopic BOS (17 patients) versus open BOS (38 patients).
• Comparison of remnant cystic duct closure by suture ligation (22 patients) versus clipping/ligation (35 patients).

Main Results:

• Open BOS was associated with higher CRP, WBC, NLR, and CAR levels.
• Open BOS resulted in significantly longer hospitalization, operating time, and bleeding.
• Suture closure was more frequent in patients with prior endoscopic lithotripsy (EL).

Conclusions:

• Laparoscopic BOS is a feasible and effective approach for difficult cholecystectomies.
• Laparoscopic BOS offers advantages over open BOS, including reduced inflammation and shorter recovery.
• Preoperative EL may increase the need for suture closure of the cystic duct.