Journal of laparoscopic surgery
Objective: To investigate the emergent management and operative technique of difficult laparoscopic cholecystectomy( LC). Methods: The clinical data of 106 patients who underwent difficult LC from Aug. 2002 to Oct. 2011 were retrospectively analyzed. Results: One hundred and one cases of LC were successful,among these cases there were 9 cases of gallbladder artery variation,23 cases of local or abdominal adhesion,13 cases of local accumulation of fat,3 cases of liver lobe hypertrophy,11 cases of calculus incarcerated in cystic duct or neck,1 case of type Ⅰ Mirizzi syndrome,11 cases of gallbladder atrophy,8 cases of gallbladder in liver,2cases of cystic duct variation,8 cases of huge calculus,7 cases of fully filled gallbladder calculus,5 cases of hyperemia,ecpyesis and gangrene of gallbladder and incrassation of gallbladder wall( ≥0. 6 cm). 5 cases of LC were not successful: 1 case of laparoscopic fistulization of gallbladder,4 cases were converted to open operation. 1 patient had the abdominal operation history and failed to establish pneumoperitoneum by open method,1 case was difficult in hemostasis of errhysis at gallbladder bed,2 cases of gallbladder triangle area were frozen like change. Operation time was( 139. 5 ± 46. 0) min( range,60-240 min),intraoperative blood loss during operation was( 85. 7 ± 49. 9) ml( range,10-200 ml). Drainage tube was placed in 69 cases,postoperative drainage liquid was light bloody,drainage amount was( 39. 4 ± 20. 3) ml / d( range,10-80 ml / d). The drainage tube was removed in( 4. 75 ± 1. 09) d( range,3-7 d) after operation. Postoperative hospital stay was( 6. 15 ± 1. 98) d( range,3-11 d). 81 patients were followed up for( 6. 82 ± 1. 95) months( range,3-12 months),6 cases occurred dull pain at right upper quadrant,and recovered after using xiaoyanlidan tablet for half a month; 5 cases of glutted right upper quadrant,4 cases of light diarrhea disappeared within 3 months. Other patients did not suffer from undesirable complications. Conclusions: For the difficult LC,surgeons should be firm and steady,cannot be hurry and confusious,follow the principle of "careful distinguishing the structure,dissection near the gallbladder,sequent-converse combination,sharp and blunt combination,combination of anterior and posterior gallbladder triangle during separation,gallbladder could be damaged,intestine,liver,bile duct must not be damaged". With the principle,most operations can be smoothly completed,and subtotal cholecystectomy and con-version to open operation can reduce the unexpected damage.