2020 Volume 34 Issue 1 Pages 33-39
In the Tokyo Guidelines 2018, safe steps for laparoscopic cholecystectomy (LC) for acute cholecystitis are shown. Among these, the recommendation to choose bailout procedures to avoid bile duct damage in patients in whom the surgery would be difficult is included.
LC is most difficult in patients with chronic cholecystitis, in which the layers of the gallbladder wall have disappeared and become scarred due to repeated cholecystitis. If ablation at the Calot's triangle is difficult, a fundus first technique wherein an incision is made from the fundus of the gallbladder toward the neck should be selected. If ablation of the cystic duct is difficult, a subtotal cholecystectomy should be performed. Although an open conversion can be performed in some cases when surgery is challenging, it cannot always be said that the LC technique will become easier with open conversion. The decision to perform these bailout procedures should be made appropriately considering the skill of the surgeon.
