Original ResearchRetroinfundibular laparoscopic cholecystectomy versus standard laparoscopic cholecystectomy in difficult cases

•Difficult cholecystectomy is struggling surgical problem.•The critical view of safety can't be achieved.•There is high incidence of complications.•Retroinfundibular laparoscopic cholecystectomy is safe and feasible alternative to conversion to open.

BackgroundLaparoscopic cholecystectomy becomes the gold standard surgical procedure for treating gallstones. Standard laparoscopic cholecystectomy (SLC) requires proper dissection of Calot's triangle to achieve the critical view of safety. This may be difficult in certain conditions, resulting in higher incidence of bile duct injury and conversion to open. We aimed to compare the outcomes of laparoscopic cholecystectomy by retroinfundibular (RI) approach to that of SLC, in difficult cases.Patients and methodsThis study is prospective cohort study, in which 60 patients were operated by SLC and 65 patients by laparoscopic cholecystectomy by RI approach.ResultsFrom the total 125 cases, 95 (76%) patients were male and 30 (24%) were female. The mean age was 59.5 ± 5.5 years. The mean operative time in SLC group was 128 ± 17 min VS. 114 ± 10 min in RI group. Conversion to open occurred in 10% in SLC group VS. 1.5% in RI group. Biliary injury occurred in 3.3% in SLC group VS. 0% in RI group. The mean hospital stay in SLC was 3.7 ± 5.3 days VS. 2.1 ± 0.3 days in RI group.ConclusionIn difficult cholecystectomy, RI approach is feasible and safe alternative to SLC.