Conditions associated with a difficult cholecystectomy

Difficulty in operative access and exposure:

Previous upper abdominal surgery

Obesity

Inflammatory processes involving the gallbladder:

Severe chronic cholecystitis

Older age, male sex

Multiple prior attacks of biliary colic

Thickened gallbladder wall on ultrasound

Shrunken, contracted gallbladder on imaging

Acute cholecystitis

Gangrenous cholecystitis

Emphysematous cholecystitis

Perforated gallbladder

Mirizzi's syndrome

Other conditions:

Cirrhosis

A difficult cholecystectomy may be predicted preoperatively based on these patient characteristics, based on which the surgeon should take steps to ensure the safe performance of the procedure.

Graphic 113919 Version 1.0

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