The effect of various surgical techniques in difficult cholecystectomy: A retrospective cohort study

Background: Success of laparoscopic cholecystectomy depends on multiple factors.Knowledge about altered anatomy, physiology and pathology of gall bladder, and thesurgeons experience in applying different surgical technique during difficult cholecystectomyare collectively important for a safe outcome.Methods: A total data of 875 patients who underwent cholecystectomy were analysed from June 2014 to May 2019. Study was mainly focused on looking for various intraoperative findings that could be the reason for conversion to open cholecystectomy in patients with difficult anatomy, physiology and pathology associated gall stone disease.Results: about 279/875 (31.9%) had difficult gall bladder with altered anatomy and pathology. Overall, conversion rate among difficult laparoscopic cholecystectomy was 62/279 (22.2%). 36/875 (2.4%) patients undergone subtotal cholecystectomy. 1/875 (0.1%)had common bile duct injury underwent repair. 54/875 (61.7%) had developed overall complications and 1/875 (0.1%) died due sepsis.Conclusion: High conversion rate and complications are seen in patients with contracted gallbladder and adhesions due to previous intervention. Conversion from laparoscopic cholecystectomy to open cholecystectomy is not a complication but continuum of treatment to reduce morbidity. Use of the critical view of safety technique very useful.