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The Difficult Cholecystectomy

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The SAGES Manual of Biliary Surgery

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Abstract

A number of conditions can be associated with increased difficulty of cholecystectomy. These include acute cholecystitis, severe chronic cholecystitis, Mirizzi syndrome, cirrhosis, and other non-gallbladder-related factors such as morbid obesity and extensive previous upper abdominal surgery. Preoperative recognition and awareness as well as modifications of technical strategies are important to a successful outcome and avoiding major complications in these patients. Percutaneous cholecystostomy tube drainage is an important option in patients with severe acute cholecystitis who are too high risk to undergo surgery. At operation, if it is not possible to obtain the critical view of safety, an operative bailout strategy should be considered such as surgical tube cholecystostomy, laparoscopic subtotal cholecystostomy, conversion to an open operation, or aborting the procedure. This chapter will review conditions that increase the difficulty of cholecystectomy and will highlight technical modifications one can employ to enhance the safety of cholecystectomy in these patients.

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Author information

Authors and Affiliations

  1. Section of Minimally Invasive Surgery, University of Tennessee – Memphis, Memphis, TN, USA

    Nathaniel Stoikes

  2. Section of Minimally Invasive Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, Saint Louis, MO, USA

    L. Michael Brunt

Authors
  1. Nathaniel Stoikes
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  2. L. Michael Brunt
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Corresponding author

Correspondence to L. Michael Brunt .

Editor information

Editors and Affiliations

  1. Chief of HPB - Miami Cancer Institute, Miami, FL, USA

    Horacio J. Asbun

  2. Assistant Professor of Surgery, Winship Cancer Institute, Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Mihir M. Shah

  3. Associate Professor of Surgery, University of New Mexico, School of Medicine, Indianapolis, IN, USA

    Eugene P. Ceppa

  4. Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM, USA

    Edward D. Auyang

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© 2020 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)

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Stoikes, N., Brunt, L.M. (2020). The Difficult Cholecystectomy. In: Asbun, H., Shah, M., Ceppa, E., Auyang, E. (eds) The SAGES Manual of Biliary Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-13276-7_11

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  • DOI: https://doi.org/10.1007/978-3-030-13276-7_11

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-13275-0

  • Online ISBN: 978-3-030-13276-7

  • eBook Packages: MedicineMedicine (R0)

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