Abstract
Summary
Background
Cholecystectomy may be difficult and hazardous, causing major morbidity and mortality. This review aims to identify situations increasing the probability of difficult gallbladders and present today’s best practice to overcome them.
Methods
Review of the literature and expert comment.
Results
One in six gallbladders is expected to be a difficult cholecystectomy. The majority can be predicted by patient history, clinical symptoms, and pre-existing comorbidities. Acute cholecystitis, mild biliary pancreatitis, prior endoscopic sphincterotomy, and liver cirrhosis are the predominant underlying diseases. Early or delayed cholecystectomy, percutaneous cholecystostomy, and pure conservative treatment are evidence-based options. Early laparoscopic cholecystectomy is of advantage in patients fit for surgery, with subtotal cholecystectomy or conversion to open surgery as bail-out strategies. The choice of the procedure depends on the experience of the surgeon.
Conclusion
Clinical decisions should follow a pathway based on patients’ risk, favoring laparoscopic cholecystectomy whenever possible. The implementation of an institutional pathway to deal with difficult gallbladders is recommended.
Funder
Johannes Kepler University Linz
Publisher
Springer Science and Business Media LLC
Reference37 articles.
1. Spohnholz J, Herzog T, Munding J, et al. Conversion cholecystectomy in patients with acute cholecystitis—it’s not as black as it’s painted! Langenbecks Arch Surg. 2016;401(4):479–88.
2. Ashfaq A, Ahmadieh K, Shah AA, Chapital AB, Harold KL, Johnson DJ. The difficult gall bladder: outcomes following laparoscopic cholecystectomy and the need for open conversion. Am J Surg. 2016;212:1261–4.
3. Strasberg SM, Pucci MJ, Brunt LM, Deziel DJ, et al. Subtotal choleycstectomy - “Fenestrating” vs “Reconstituting” subtypes and the prevention of bile duct injury: definition of the optimal procedure in difficult operative conditions. J Am Coll Surg. 2016;222(1):89–96.
4. Salky BA, Edye MB, et al. The difficult cholecystectomy: problems related to concomitant diseases. Semin Laparosc Surg. 1998;5(2):107–14.
5. Adamer K, Salzmann M, Imhof M, Zacherl J, Raduly F, Függer R et al. Postoperative benefit after laparoscopic cholecystectomy in acute cholecystitis. Zentralbl Chir. 1997;122(4):287–90.
Cited by
4 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献