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Difficult Cholecystectomy

This document discusses difficult cholecystectomies. It identifies factors that can make cholecystectomies difficult including difficult anatomy, pathology, obesity, and improper retraction. It emphasizes achieving the Critical View of Safety during surgery and provides bailout options if the surgery becomes too difficult, such as subtotal or fenestrating cholecystectomies. Surgeons are advised to call for help if a case becomes difficult and consider conversion to open surgery.

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Euis W
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56 views20 pages

Difficult Cholecystectomy

This document discusses difficult cholecystectomies. It identifies factors that can make cholecystectomies difficult including difficult anatomy, pathology, obesity, and improper retraction. It emphasizes achieving the Critical View of Safety during surgery and provides bailout options if the surgery becomes too difficult, such as subtotal or fenestrating cholecystectomies. Surgeons are advised to call for help if a case becomes difficult and consider conversion to open surgery.

Uploaded by

Euis W
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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DIFFICULT

CHOLECYSTECTOMY
Simple cholecystectomy
DIFFICULT CHOLECYSTECTOMY
Difficult Surgery

Difficult Anatomy
DIFFICULT CHOLECYSTECTOMY

Difficult Pathology
Difficulty predicting factors
Clinical parameters
(Patient factors and
Disease factors)

Radiological parameters

Intra operative
parameters
Clinical parameters
Patient factors Disease factors:
• Acute cholecystitis
• Pancreatitis
• Pre operative ERCP
• Palpable GB
Radiological parameters
Intra operative parameters
Patients with significant visceral
obesity
The Critical View of Safety, only 2 tubular
structures entering the GB
Improper retraction of GB tents common
hepatic/bile duct
Horizontal plane created by Rouviere’s sulcus  landmark
Surgical decision-making on Difficult
Cholecystectomy
Clues:
Call for help

Conversion
to open
Scoring Index/Prediction of difficulty
Bailout options on Difficult
Cholecystectomy
Subtotal “fenestrating” cholecystectomy
Leave Hartmann’s
pouch,
If unable to identify
the cystic duct.

Remove all the


stones from the
gallbladder.
Subtotal “fenestrating” cholecystectomy

Leave
posterior wall
of gallbladder.

Suture closed
cystuc duct
orifice from
inside GB.
Take home message:
Thank You

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