Critical view of safety (cvs) in laparoscopic cholecystectomy; what if you fail to establish?

Abstract

Background: Laparoscopic Cholecystectomy (LC) is the gold standard surgical procedure for removal of gall bladder. However in difficult situations, it is customary to convert it to an open procedure. Methods: A prospective data analysis was done for 208 consecutive cases of LC performed in a surgical unit at National Hospital of Sri Lanka from September 2012 to January 2017. Results: Out of 208 patients, 152 were women (73.1%) with a mean age of 47.6 years (range 21-79). Biliary colic (37.5%), chronic cholecystitis (31.6%) and acute cholecystitis (10.1%) were the commonest indications for LC. Eighteen patients who had CBD stones underwent CBD exploration simultaneously. Among 208 cases 19 had empyema, 8 had mucocoele and 1 had choledochoduodenal fistula. In 31 difficult cases retrograde cholecystectomy was performed and out of them 9 patients underwent subtotal cholecystectomy. All cases were successfully managed laparoscopically with zero conversion rate. Bile spillage was the commonest complication (21.4%) and average postoperative hospital stay was 2.9 days. Conclusion: With safe dissection and timely resorting to retrograde cholecystectomy in experienced hands, there seems to be no reason for conversion to open cholecystectomy. Most of the complicated cases can be successfully managed laparoscopically without conversion to open procedure.