Volume : 5, Issue : 3, March - 2016

Difficult Cholecystectomy Strategies in Laparoscopic Cholecystectomy: A Study

Hans Raj Ranga, Bhavinder Arora

Abstract :

<p>&nbsp;Background: In the beginning of era of laparoscopic cholecystectomy, only simple gall stone disease was thought to be amenable to laparoscopic cholecystectomy. With gaining experience, certain risk factors have been identified for predicting difficult cholecystectomy. These risk factors include dense adhesions, acute cholecystitis, contracted gall bladder, mucocele and empyema of gall bladder, male patients who are obese, diabetes, chronic liver diseases, cholecystoduodenal fistula and Mirrizzi&rsquo;s syndrome. Material and methods: This study was carried out on a total of 114 patients suffering from gall stone disease. In all the patients four ports laproscopic cholecystectomy was done. The patients were assessed clinically for inflammation. The haematological investigations were done in all the patients. The preoperative ultrasound was done in these patients for pre operative assessment of diagnosis and assignment of a patient to difficult gall bladder. The standard four port technique was used for laparoscopic cholecystectomy. Results: Out 114 patients, dense adhesions were present in 25 patients, contracted gall bladder in 24, acute cholecystitis in 9, obese male 3, diabetes 4, empyema and mucocele in 3 and 4 patients respectively. Conclusion: Removal of gall bladder by laparoscopic method at times poses technical challenges due to various reasons, and at times non existing problems can be encountered but most of the problems can be safely managed with laparoscopy with minimal morbidity, safety should be given priority, to avoid complications and threshold for conversion should be kept low.</p>