The Strategies for the Performance of Difficult Laparoscopic Cholecystectomies and the Management of Its Postoperative Complications—With the Experience from 278 Cases  

作　　者：Yousheng Lin Yuanhan Kun Tanxi Juan Chensi Zong Luozong Jiang Luli Bai Lu Yuan Wangjian Chu Yousheng Lin;Yuanhan Kun;Tanxi Juan;Chensi Zong;Luozong Jiang;Luli Bai;Lu Yuan;Wangjian Chu(Department of Hepatobiliary Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China)

机构地区：[1]Department of Hepatobiliary Surgery, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China

出　　处：《Journal of Biosciences and Medicines》2024年第12期229-235,共7页生物科学与医学(英文)

摘　　要：Background: Laparoscopic cholecystectomy (LC) remains the preferred me-thod for treating benign gallbladder diseases. However, clinical presentations of cholecystitis vary widely. For severely inflamed cases, LC can be challenging. Objectives: This study aimed to explore intraoperative strategies and postoperative management of complications during difficult LC to further enhance its safety. Methods: We retrospectively analyzed data from difficult LC procedures performed by the same expert at our hospital between January 2016 and December 2022. The surgical approach, handling methods, operative time, and postoperative complications were evaluated. Results: Utilizing techniques such as thin-layer progressive dissection, suction and blunt dissection, reverse resection, partial cystectomy, we successfully completed difficult LC in 278 cases. All surgeries were accomplished under laparoscopy. Five cases (0.72%) experienced bile leakage which was managed through drainage tube fistula formation before removal;there were no incidences of hemorrhage, abdominal infection, or biliary tract injury. Conclusion: Our series showed that difficult LC had high safety and low rates of conversion to open surgery and complications. The safety of complex gallbladder removal is related to the surgeon’s experience and proficiency in laparoscopic skills. Postoperative bile leakage can be effectively treated through drainage tube fistula formation.Background: Laparoscopic cholecystectomy (LC) remains the preferred me-thod for treating benign gallbladder diseases. However, clinical presentations of cholecystitis vary widely. For severely inflamed cases, LC can be challenging. Objectives: This study aimed to explore intraoperative strategies and postoperative management of complications during difficult LC to further enhance its safety. Methods: We retrospectively analyzed data from difficult LC procedures performed by the same expert at our hospital between January 2016 and December 2022. The surgical approach, handling methods, operative time, and postoperative complications were evaluated. Results: Utilizing techniques such as thin-layer progressive dissection, suction and blunt dissection, reverse resection, partial cystectomy, we successfully completed difficult LC in 278 cases. All surgeries were accomplished under laparoscopy. Five cases (0.72%) experienced bile leakage which was managed through drainage tube fistula formation before removal;there were no incidences of hemorrhage, abdominal infection, or biliary tract injury. Conclusion: Our series showed that difficult LC had high safety and low rates of conversion to open surgery and complications. The safety of complex gallbladder removal is related to the surgeon’s experience and proficiency in laparoscopic skills. Postoperative bile leakage can be effectively treated through drainage tube fistula formation.

关 键 词：Difficult Laparoscopic Cholecystectomy Operative Strategies Cystic Duct Bile Leakage Gallbladder Triangle 

分 类 号：R65[医药卫生—外科学]