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  • Difficult Cholecystectomy

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    Euis W
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    This document discusses difficult cholecystectomies. It identifies factors that can make cholecystectomies difficult including difficult anatomy, pathology, obesity, and improper retraction. It emphasizes achieving the Critical View of Safety during surgery and provides bailout options if the surgery becomes too difficult, such as subtotal or fenestrating cholecystectomies. Surgeons are advised to call for help if a case becomes difficult and consider conversion to open surgery.

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    Of u want know but cole

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    Cole

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    This document discusses difficult cholecystectomies. It identifies factors that can make cholecystectomies difficult including difficult anatomy, pathology, obesity, and improper retraction. It emphasizes achieving the Critical View of Safety during surgery and provides bailout options if the surgery becomes too difficult, such as subtotal or fenestrating cholecystectomies. Surgeons are advised to call for help if a case becomes difficult and consider conversion to open surgery.

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    © All Rights Reserved
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    Download as pdf or txt
    27 views20 pages

    Difficult Cholecystectomy

    Uploaded by

    Euis W
    This document discusses difficult cholecystectomies. It identifies factors that can make cholecystectomies difficult including difficult anatomy, pathology, obesity, and improper retraction. It emphasizes achieving the Critical View of Safety during surgery and provides bailout options if the surgery becomes too difficult, such as subtotal or fenestrating cholecystectomies. Surgeons are advised to call for help if a case becomes difficult and consider conversion to open surgery.

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    of 20

    DIFFICULT

    CHOLECYSTECTOMY
    Simple cholecystectomy
    DIFFICULT CHOLECYSTECTOMY
    Difficult Surgery

    Difficult Anatomy
    DIFFICULT CHOLECYSTECTOMY

    Difficult Pathology
    Difficulty predicting factors
    Clinical parameters
    (Patient factors and
    Disease factors)

    Radiological parameters

    Intra operative
    parameters
    Clinical parameters
    Patient factors Disease factors:
    • Acute cholecystitis
    • Pancreatitis
    • Pre operative ERCP
    • Palpable GB
    Radiological parameters
    Intra operative parameters
    Patients with significant visceral
    obesity
    The Critical View of Safety, only 2 tubular
    structures entering the GB
    Improper retraction of GB tents common
    hepatic/bile duct
    Horizontal plane created by Rouviere’s sulcus  landmark
    Surgical decision-making on Difficult
    Cholecystectomy
    Clues:
    Call for help

    Conversion
    to open
    Scoring Index/Prediction of difficulty
    Bailout options on Difficult
    Cholecystectomy
    Subtotal “fenestrating” cholecystectomy
    Leave Hartmann’s
    pouch,
    If unable to identify
    the cystic duct.

    Remove all the


    stones from the
    gallbladder.
    Subtotal “fenestrating” cholecystectomy

    Leave
    posterior wall
    of gallbladder.

    Suture closed
    cystuc duct
    orifice from
    inside GB.
    Take home message:
    Thank You

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