Difficult Laparoscopic Cholecystectomy

Abstract

Laparoscopic cholecystectomy is as much easy procedure as difficult one. Surgeon should consider every case as his first one. Intraoperative complications are common while transformation to open surgery should be always in consideration. Transformation to open cholecystectomy isn't a sign of lack of experience, rather it is a proof of surgeon cleverness and an evidence of professional competence as it could keep our patient away from life-threatening complications in difficult situations.
 
 Predictive factors for difficulty vary from male patient, repeated acute attacks, history of obstructive jaundice, presence of abnormal anatomical or pathological findings, and adhesions.
 
 The aim of this study was to assess some preoperative causes namely by history, clinical examination and, radiological data which can dependably anticipate the odds of troublesome laparoscopic Cholecystectomy or alteration to open Cholecystectomy .1005 patients experienced laparoscopic cholecystectomy 171 of them were difficult cases (10.05%). Transformation rate in our study is within the lower limits and accepted internationally. Dense fibrous adhesion and bleeding are the main causes of transformation. History of acute cholecystitis is separate hazard factor for transformation from laparoscopic to open procedure. Gender and age are also showing increasing rate of transformation.
 
 Results shown bile duct damages may evaded even with nearness of hazard factors as anatomical variations from the of biliary channels, intense cholecystitis, extreme endless fibrosis, affected stones inside Hartmann pocket, and short cystic pipe during laparoscopic cholecystectomy by careful watching and wise decision of transformation whenever surgeon feels risk of major complication in case of proceeding in laparoscopic technique.
 
 Mortality not encountered directly through the procedure or in short post-operative period but as sequel of complicated cases. Authors proposes that change of the laparoscopic cholecystectomy isn't really a disappointment of the specialist, as usually explained, yet is a lifesaving method as delineated by the results of the study. The experience of the operating surgeon assumes an essential function on this subject.

Laparoscopic cholecystectomy for gallbladder stone disease:preoperative factors associated with difficult operations

“…In the current study found female preponderance (88.1%), a finding which is in consistence with several study reports [2,6,12,15,21,22,23,27,28]. High incidence of gallstones in females has been suggested due to the effect of estrogen and progesterone on biliary cholesterol level and gallbladder motility [2,6].…”

“…In this study, difficult laparoscopic cholecystectomy confronted the surgical team in 137 patients (33.8%), which is similar to what were reported by Atta H et al (32%) [7], Mudgal M (34%) [15], as well as Singh K et al (34%) [22], and located between the two extreme ratios which were mentioned by Nidoni R et al (24.4%) [17],and Verma D et al (46%) [29]. The study showed conversion rate of 6.4%, which compares well with the incidence reported in the literature, which varies from 2-15% [6,17,21,22,23].…”

“…In many published studies, age is recognized as a risk factor for difficult laparoscopic cholecystectomy [2,6]. However, this study did not revealed statistically significant association between age and difficult laparoscopic cholecystectomy.…”

“…Laparoscopic cholecystectomy has become the treatment of choice for symptomatic cholelithiasis [17], because it has several physiological advantages over open cholecystectomy, such as less post operative pain, faster return of bowel function, shorter hospital stay. It can be carried out with reduced morbidity and mortality [1,2,6,7,8] . Indeed, it is considered to be the most common laparoscopic procedure in general surgery [12].…”