Body First Approach of Laparoscopic Cholecystectomy for Difficult Gallbladder

Area of Science:

• Laparoscopic surgery
• Gastrointestinal surgery
• Surgical innovation

Background:

• Laparoscopic cholecystectomy for acute cholecystitis can be challenging due to severe inflammation obscuring anatomy.
• Difficult cases increase the risk of complications and conversion to open surgery.

Purpose of the Study:

• To evaluate the effectiveness of the "body-first approach" in laparoscopic cholecystectomy for acute cholecystitis.
• To determine if this approach impacts conversion rates and completeness of gallbladder removal.

Main Methods:

• A retrospective study comparing 205 patients with acute cholecystitis undergoing cholecystectomy.
• Patients were divided into two groups: before and after the implementation of the body-first approach (from July 2022).
• Key outcomes analyzed included conversion rate to laparotomy and total cholecystectomy rate.

Main Results:

• The body-first approach group showed a significantly lower conversion rate to open surgery (p=0.000629).
• The total cholecystectomy rate was significantly higher in the body-first approach group (p=0.00012).
• No significant differences in patient demographics or operative difficulty grading were observed; no cases of vascular-biliary injury occurred.

Conclusions:

• The body-first approach is effective in managing difficult gallbladders during laparoscopic cholecystectomy for acute cholecystitis.
• This technique improves surgical outcomes by reducing the need for conversion to open procedures and increasing complete gallbladder resection.
• The approach is associated with a low risk of complications, including vascular-biliary injury.