Vol. 1, Issue 1, Part A (2017)

Background: Laparoscopic cholecystectomy (LC) has become the gold standard for treating symptomatic gallstone disease. However, in cases labeled as "difficult gall bladders," factors such as dense adhesions, anatomical distortion, or acute inflammation can complicate dissection and increase the risk of bile duct injury, often necessitating conversion to open cholecystectomy (OC). Identifying predictive factors for conversion can aid in surgical planning and patient counseling.

Materials and Methods: This prospective observational study was conducted over 18 months in a tertiary care surgical center. A total of 120 patients diagnosed with symptomatic cholelithiasis were scheduled for elective laparoscopic cholecystectomy. Intraoperative findings were assessed, and cases were classified as difficult based on operative criteria including Calot’s triangle inflammation, presence of empyema, and dense adhesions. The rate and reasons for conversion to open cholecystectomy were documented. Operative time, intraoperative complications, and hospital stay were compared between converted and non-converted cases.

Results: Out of 120 patients, 28 (23.3%) had intraoperative findings suggestive of a difficult gall bladder. Conversion to open cholecystectomy was required in 12 cases (10%). The most common reasons for conversion included dense adhesions (5 cases), unclear anatomy at Calot’s triangle (4 cases), and uncontrolled bleeding (3 cases). The mean operative time for converted cases was 110 ± 15 minutes, compared to 65 ± 12 minutes for completed laparoscopic cases. Postoperative hospital stay was significantly longer in the converted group (5.8 ± 1.2 days vs. 2.3 ± 0.9 days). There was one case of bile duct injury in the laparoscopic group and none in the converted group.

Conclusion: Difficult gall bladder remains a major challenge in laparoscopic cholecystectomy, often necessitating conversion to open surgery to ensure patient safety. Early recognition of difficult intraoperative findings and timely conversion can reduce complications. Preoperative predictors and meticulous surgical judgment play a pivotal role in decision-making.