European Journal of Molecular & Clinical Medicine

Abstract

Aim: Purpose of the present study was to evaluate the risk in cases of laproscopic cholecystectomy
Methodology: A Medline search was conducted to review all published English literatures relevant to difficult cholecystectomy through 2009 to 2022. The search words were “laparoscopic cholecystectomy,” “difficult cholecystectomy,” “difficult laparoscopy,” “subtotal laparoscopiccholecystectomy,” “fundus first cholecystectomy,” and “causes of conversion of laparoscopic cholecystectomy.”
Results: Sixty-seven studies, which included 324,553 patients, were selected for this review. Five major categories of difficulty were identified. Conversion rate and iatrogenic injuries during laparoscopic cholecystectomy are still high despite significant improvement over the last 10 years. Depending on the technique of cholecystectomy, the degree of gall bladder inflammation, patient comorbidities, and surgical experience, the conversion rate was reported between 0.18% and 30%, whereas the incidence of iatrogenic injuries was from 0% to 0.6%. Subtotal cholecystectomy, antegrade and fundus first techniques, and pre-operative cholangiogram were associated with lower complications and conversion rate. Risk factors for difficulty were male sex, increased age, acute and thick wall chronic cholecystitis, wide and short cystic duct, cholecysto-digestive fistula, previous upper abdominal surgery, obesity, liver cirrhosis, anatomic variation, cholangiocarcinoma, and low surgeon’s caseload.
Conclusion: No consensus is found among surgeons on how to manage difficult laparoscopic cholecystectomy. Iatrogenic injuries and conversion rate can be reduced depending on the surgeon’s experience, special techniques, and intraoperative investigations