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All surgeons will encounter difficult cholecystectomies. Many trying and untenable situations can be prevented or made easier by the cautious surgeon who has a carefully thought-out plan for each potential problem. Step-by-step, this article addresses the arduous challenges that may be faced...
Laparoscopic cholecystectomy is the procedure of choice for symptomatic cholelithiasis. However, in the presence of acute cholecystitis, 10% to 15% of patients face conversion to laparotomy. Alternatives to conventional therapy may therefore help to improve the clinical outcome of patients with...
Symptomatic biliary disease during pregnancy may have serious consequences for both the mother and the fetus. Laparoscopic cholecystectomy was felt initially to be contraindicated in pregnancy, but clinical experience accumulated since 1991 has been extremely favorable. Specialists in the areas...
Carcinoma of the gallbladder is a rare disease, but when encountered in the patient undergoing laparoscopic cholecystectomy, it can pose a number of dilemmas. Familiarity with the risk factors for malignant gallbladder disease can help identify patients in whom more extensive preoperative...
In the decade since the clinical arrival of laparoscopic cholecystectomy, there have been gratifying improvements in imaging technology and instrumentation, and innovative techniques have evolved. Laboratory-simulator devices are available for basic skills exercises and can at least reasonably...
The difficult gallbladder is the most common "difficult" laparoscopic surgery performed by general surgeons. It is also "potentially" the one that places the patient at significant risk. This article reports on our first 1,900 laparoscopic cholecystectomies. With this report, it is the desire of...
The laparoscopic approach to acute cholecystitis is not only feasible, but it is also a cost-effective, safe, and beneficial treatment option in selected patients. Patients undergoing laparoscopic surgery for acute cholecystitis seem to enjoy the same benefits of diminished pain and shorter...
Proper management of iatrogenic bile duct injuries is mandatory to avoid immediate or late life threatening sequelae. Results of surgery depend mainly on the type of injury and the timing of surgery. Lesions detected during cholecystectomy should be repaired immediately, preferably with an...
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