title: The Difficult Gallbladder: A Safe Approach to a Dangerous Problem.
abstract: Laparoscopic cholecystectomy is a common surgical procedure, and remains the gold standard for the management of benign gallbladder and biliary disease. While this procedure can be technically straightforward, it can also represent one of the most challenging operations facing surgeons. This dichotomy of a routine operation performed so commonly that poses such a hidden risk of severe complications, such as bile duct injury, must keep surgeons steadfast in the pursuit of safety. The "difficult gallbladder" requires strict adherence to the Culture of Safety in Cholecystectomy, which promotes safety first and assists surgeons in managing or avoiding difficult operative situations. This review will discuss the management of the difficult gallbladder and propose the use of subtotal fenestrating cholecystectomy as a definitive option during this dangerous situation.
authors.affiliation: 1 Department of Surgery, Dartmouth Geisel School of Medicine , Lebanon , New Hampshire.
authors.forename: B Fernando
authors.initials: BF
authors.lastname: Santos
authors.affiliation: 2 Department of Surgery, Washington University School of Medicine , St. Louis, Missouri.
authors.forename: L Michael
authors.initials: LM
authors.lastname: Brunt
authors.affiliation: 3 Department of Surgery, Sidney Kimmel Medical College of Thomas Jefferson University , Philadelphia, Pennsylvania.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pucci
mesh_terms: D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D005705:Gallbladder Diseases / Q000473:pathology / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control*; D012720:Severity of Illness Index
keywords: difficult gallbladder; laparoscopic cholecystectomy; subtotal fenestrating cholecystectomy