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The difficult laparoscopic cholecystectomy: a narrative review.
Hamdy S Abdallah1,2, Mohamad H Sedky3,4, Zyad H Sedky3,4
1Faculty of Medicine, Tanta University, Tanta, Egypt. hamdy.abdallah@med.tanta.edu.eg.
BMC Surgery
|April 12, 2025
Summary
Difficult laparoscopic cholecystectomy presents challenges, but subtotal cholecystectomy offers an effective bailout strategy. This approach helps prevent bile duct injuries and can be performed laparoscopically by experienced surgeons.
Area of Science:
- General Surgery
- Minimally Invasive Surgery
Background:
- Laparoscopic cholecystectomy is a frequent surgical procedure.
- Difficult cases increase operative time, complications, costs, and mortality.
Purpose of the Study:
- To conduct a comprehensive literature review on managing difficult laparoscopic cholecystectomy.
Main Methods:
- Searched PubMed, Web of Science, Google Scholar, ScienceDirect up to June 2024.
- Included clinical trials, reviews, and meta-analyses on difficult laparoscopic cholecystectomy.
- Excluded studies on pediatric, robotic, single-incision, open, or non-gallstone procedures.
Main Results:
- Emergency laparoscopic cholecystectomy for acute cholecystitis is best within 72 hours.
- Intraoperative cholangiography aids in clarifying anatomy and detecting bile duct injuries.
- Fundus-first approach and subtotal cholecystectomy are valuable when Calot's triangle dissection is hazardous.
Conclusions:
- Difficult laparoscopic cholecystectomy requires experienced surgeons and strategic approaches.
- Various bailout strategies exist, with subtotal cholecystectomy being the most effective.
- Subtotal cholecystectomy is effective in preventing bile duct injuries and is a viable laparoscopic option.
