Efficacy of laparoscopic bailout surgery for moderate and severe acute cholecystitis

"Bailout surgery" (BOS) refers to specific surgical maneuvers implemented to safely manage difficult acute cholecystitis (AC) cases and prevent complications, including massive bleeding or bile duct injury (BDI). This study validated laparoscopic BOS (lap-BOS) in moderate to severe AC cases requiring BOS. Overall, 547 patients with moderate and severe AC diagnosed per Tokyo Guideline 2018 (TG18) were retrospectively analyzed from 2020 to 2023. Of these, 129 underwent BOS, and 418 conventional laparoscopic cholecystectomy (Lap-C). Perioperative outcomes between Lap-C and BOS were compared. Patients who underwent BOS were divided into lap-BOS and conversion to open surgery (CO) groups. Patients in the BOS group were older and had higher Charlson comorbidity index scores than those in the Lap-C group. Intraoperative blood loss and operative times the rate of postoperative bile leakage were worse in the BOS group than Lap-C group. Among BOS group, the Lap-BOS group had shorter operative times, less blood loss and lower rates of complications than CO groups. BDI, postoperative bile leakage and the modified Nassar difficulty grading scales were comparable between the Lap-BOS and CO groups. Although, no differences were observed in BDI or postoperative bile leakage among Lap-C and Lap-BOS. Lap-BOS would be beneficial in avoiding common bile duct injury as for TG18 moderate and severe AC. In difficult AC cases, Lap-BOS is an alternative strategy to prevent bile duct injury of common bile duct requiring surgical intervention postoperative bile leakage and reduce intraoperative time and intraoperative bleeding rather than CO.