Outcomes of various bailout strategies for managing different categories of difficult laparoscopic cholecystectomy - An experience of over two decades from a single surgical unit at a tertiary care teaching hospital.

Abstract

Introduction: A difficult laparoscopic cholecystectomy (LC), if not handled appropriately, can lead to devastating complications. We hereby describe our experience and outcomes of patients with difficult LC over the last two decades, with various bailout strategies to achieve a very low conversion rate and bile duct injury rate.

Patients and methods: This study was a retrospective analysis of patients labelled as difficult LC in a single surgical unit at a tertiary care teaching hospital from January 2004 to December 2020. The pre-operative, peri-operative and follow-up data of all these patients were obtained from a prospectively maintained electronic database.

Results: Between January 2004 and December 2020, 3726 patients underwent elective LC, of which 649 (17.4%) cholecystectomies were deemed difficult. Using the various bailout strategies, we were able to achieve a conversion rate of 4.9% and bile duct injury rate of 0.1% with an overall morbidity of 8%.

Conclusion: When a difficult situation occurs, the benefit of removing the complete gall bladder is outweighed by the risk of a major injury, so a bailout strategy needs to be used. The present series reiterates the use of bailout strategies to not only decrease conversion but also achieve a minimal BDI rate.