The Effect of Various Surgical Techniques on Difficult Cholecystectomy Operations: A Retrospective Cohort Study

Background: Success of laparoscopic cholecystectomy depends on multiple factors. Knowledge about altered anatomy, physiology and pathology of the gall bladder, and the surgeons experience in applying different surgical techniques during difficult cholecystectomy operations are collectively important for attaining safe outcomes. Methods: Data pertaining to a total of 875 patients who underwent cholecystectomy from June 2014 to May 2019 were analyzed. The 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 or pathology associated with gall stone disease. Results: About 279/875 (31.9%) had difficult gall bladder operations with altered anatomy and pathology. Overall, conversion rate among difficult laparoscopic cholecystectomy was 62/279 (22.2%). A total of 36/875 (2.4%) patients underwent subtotal cholecystectomy. Repair of common bile duct injury was performed in 1/875 (0.1%) cases. The overall complication rate was 54/875 (6.4%); 1/875 (0.1%) died due to sepsis. Conclusion: High conversion rate and complications are seen in patients with contracted gallbladder and adhesions due to previous interventions. 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 is very useful.