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The Strategies for the Performance of Difficult Laparoscopic Cholecystectomies and the Management of Its Postoperative Complications
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Abstract:
Background: Laparoscopic cholecystectomy (LC) remains the preferred me-thod for treating benign gallbladder diseases. However, clinical presentations of cholecystitis vary widely. For severely inflamed cases, LC can be challenging. Objectives: This study aimed to explore intraoperative strategies and postoperative management of complications during difficult LC to further enhance its safety. Methods: We retrospectively analyzed data from difficult LC procedures performed by the same expert at our hospital between January 2016 and December 2022. The surgical approach, handling methods, operative time, and postoperative complications were evaluated. Results: Utilizing techniques such as thin-layer progressive dissection, suction and blunt dissection, reverse resection, partial cystectomy, we successfully completed difficult LC in 278 cases. All surgeries were accomplished under laparoscopy. Five cases (0.72%) experienced bile leakage which was managed through drainage tube fistula formation before removal; there were no incidences of hemorrhage, abdominal infection, or biliary tract injury. Conclusion: Our series showed that difficult LC had high safety and low rates of conversion to open surgery and complications. The safety of complex gallbladder removal is related to the surgeon’s experience and proficiency in laparoscopic skills. Postoperative bile leakage can be effectively treated through drainage tube fistula formation.
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