Assessment of Retro Infundibular Laparoscopic Cholecystectomy in Difficult Cases

Background: Laparoscopic 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. Objective: To evaluate the role of application of Retroinfundibular laparoscopic cholecystectomy technique during laparoscopic cholecystectomy regarding its impact on biliary and vascular injuries. Patients and methods: A clinical trial study included 30 patients with gallstone diseases which were carried out at Zagazig University Hospitals. All patients who had asymptomatic gallstone who admitted for laparoscopic cholecystectomy and were fit for laparoscopic surgery. We selected the patients that had the preoperative predictors for difficult cholecystectomy. Patients were operated on within 6 months duration. Results: There is a statistically significant difference in the distribution of patients regarding the history of previous hospitalization. Four patients (13.3%) had palpable gall bladder on preoperative abdominal examination with a statistically significant difference in the distribution of patients. Five patients (16.7%) had thick gall bladder walls on preoperative ultrasonographic examination with a statistically significant difference in the distribution of patients. Only one patient needs conversion to open a statistically significant difference in the distribution of patients. One patient had bile injury, one with bleeding, and one had infection with a statistically significant difference between those who developed complications and those who passed uncomplicated. Conclusion: Dissection to retroinfundibular area with mass ligation of cystic duct and artery is a safe and feasible alternative method to conversion to open in difficult cholecystectomy.