Laparoscopic cholecystectomy difficulties, challenges and surprises

Abstract

Introduction: Laparoscopic cholecystectomy is considered since long time as gold standard treatment for cholecystolithiasis. Preoperatively surgeon can anticipate difficulty of the procedure and prepare a plan how to deal with it. Sometimes the surgeon can be faced with a surprise intra-operatively. Methods: We collected retrospectively a series of cases subjected to laparoscopic cholecystectomy in Alexandria university from 2014 to 2017, in which there were technical or anatomical difficulties, intra-operative surprises, and how was the procedure completed safely. From 350 cases of laparoscopic cholecystectomy, 23 cases considered difficult or with intra-operative challenge. we had one case of acute cholecystitis in a child with situs invertus totalis, one case of left sided gall bladder, one case of gall stones after left donor hepatectomy, one case of heamangioma adherent to the gall bladder, one case diagnosed a huge liver cyst, one case child 4 years with acute cholecystitis and pancreatitis, five cases with previous big abdominal surgeries, one case with multiple whitish spots all over the liver, one case of accessory bile duct, three cases of caterpiller hump, two cases of stump cholecystectomy, and 4 cases of laparoscopic cholecystectomy after failed open cholecystectomy. Conclusion: Laparoscopic cholecystectomy is a frequently performed surgery with expected difficulties and challenges to the surgeons.