2020 Volume 17 Issue 3 Pages 135-141
The Tokyo Guidelines 2018 (TG18) proposed the safe steps of laparoscopic cholecystectomy for acute cholecystitis. In these guidelines, “difficult gallbladder” was defined as the presence of severe fibrosis or scarring in the Calot’s triangle, which may result in bile duct injury (BDI) and vasculobiliary injury (VBI); for these patients, TG18 proposed a bailout procedure, which includes conversion to open surgery, subtotal cholecystectomy, and fundus first technique. Our recent therapeutic results demonstrated a significant performed bailout procedures, decreased rates of conversion to open surgery and postoperative complications, significantly decreased duration of hospital stay. Appropriate definition of the “difficult gallbladder” is important. In addition, appropriate performance of a bailout procedure is important for the prevention of BDI and VBI. These management strategies may lead to better surgical outcomes for patients with acute cholecystitis.
