Case Report: Modified Laparoscopic Subtotal Cholecystectomy: An Alternative Approach to the “Difficult Gallbladder”

Patient: Male, 56 Final Diagnosis: Acute cholecystitis Symptoms: Abdominal pain Medication:— Clinical Procedure: Laparoscopic subtotal cholecystectomy Specialty: Surgery OBJECTIVE: Unusual clinical course BACKGROUND: Laparoscopic cholecystectomy is a commonly performed surgical procedure. In certain situations visualization of the Callot triangle can become difficult due to inflammation, adhesions, and sclerosing of the anatomy. Without being able to obtain the “critical view of safety” (CVS), there is increased risk of damage to vital structures. An alternative approach to the conventional conversion to an open cholecystectomy (OC) would be a laparoscopic subtotal cholecystectomy (LSC). CASE REPORT: We present a case of a 56-year-old male patient with acute cholecystitis with a “difficult gallbladder” managed with LSC. Due to poor visualization of the Callot triangle due to adhesions, safe dissection was not feasible. In an effort to avoid injury to the common bile duct (CBD), dissection began at the dome of the gallbladder allowing an alternative view while ensuring safety of critical structures. CONCLUSIONS: We discuss the potential benefits and risks of LSC versus conversion to OC. Our discussion incorporates the pathophysiology that allows LSC in this particular circumstance to be successful, and the considerations a surgeon faces in making a decision in management.