Abstract

Laparoscopic cholecystectomy is one of the most common surgical procedures performed. Difficult gall bladder is difficult to define. In this study we tried to precisely define difficult gall bladder. We tried to study patient factors affecting pre operatively, investigations predicting difficult gall bladder and worked out system predicting degree of difficulty intra operatively. Aims and Objectives: To study of complex cholecystectomy performed with Laparoscopic Surgery: our experiences. Materials and Methods: In this prospective study, was conducted in the Department of surgery of Jawahar Lal Nehru Medical College and Hospital, Bhagalpur and Nalanda Medical College and Hospital, Patna, Bihar, India, between October 2021 and September 2022. Total of 42 cases of complex gall bladder who underwent laproscopic cholecystectomy successfully, 2males and 1female cases converted to open cholecystectomy as it was need of the time for betterment of patients. Results and Observations: In our study most of the cases are from the age group 31-40 i.e. 11 cases (26%), followed by 41-50 i.e.7 cases (16.66%) female patients were more i.e. 23 cases (54.8%) than male i.e. 19 cases (45.2%) with female to male ratio 1:0.8. Conclusion: Laparoscopic cholecystectomy is a safe procedure for gall stone diseases. However, some patients need conversion to standard protocol like Laparoscopic subtotal cholecystectomy and laparoscopic partial cholecystectomy. Our study concluded that ultrasonography is important tool not only for diagnosis of gall bladder pathology but for anticipating difficulties preoperatively which helped to plan for intraoperative management also. Most important thing is surgeon’s skill. An experienced surgeon can manage all technically difficult gall bladders laparoscopically. Whereas, open surgery is the better option in some patients having reasons, frozen Calot’s tringle, cholecysto-colic adhesions and no CBD/Bile duct explorations.

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