الفهرس 
Material and methodsOnly 14 pages are availabe for public view
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Abstract
Laparoscopic cholecystectomy has become the most prevalent
method of treating uncomplicated symptomatic cholelithiasis because it
has become quite safe, minimally invasive, and associated with an
acceptable rate of morbidity as long as the operating team has obtained the
necessary expertise. As the experience with this procedure grow, certain
pitfalls and difficulties are becoming apparent.
At the start of our study we excluded the patients presenting with
syptoms of acute cholecystitis (in the selection of the patients). With
increasing experience we followed the ”all comers” policy and excluded
only the patients who were unfit for anesthesia, and those with peritonitis
and stone common bile duct.
In our study no intraoperative deaths occurred but intraoperative
difficulties were encountered in 38 patients (13.5%), 6 of those patients
(2.1%) were reverted to open cholecystectomy due to major difficulties,
where trials failed to complete the procedure laparoscopically. The other
difficulties were overcomed by some modifications and maneovurs with
only increasing the duration of the procedures.
The difficulties were encountered in insufflation and trocar entry,
grasping the gallbladder, exposure of the hepatocystic triangle, dissection
of the cystic duct and vessels, dissection of the gallbladder from its hepatic
bed or during extraction of the gallbladder.
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The average operative time was of 42 minutes with a range of 25 to
100 minutes depending on the experience of the surgical team and the
type of difficulty met with.
Post operative complications were almostly mmor and most
patients were discharged at the night of the operative day.
In conclusion, the difficulties that encountered the surgeon might be
severe that conversion to an open procedure was mandatory in most of
them as in cases with marked dense adhesions due to previous major upper
abdominal operations, uncontrolled bleeding from major vessel, dilated
biliary duct or intraoperative injury of an important structure.
On the other hand, difficulties encountered might be either moderate
that only increased the time of procedure without the need for conversion
to an open method as in cases of perforation or difficult extraction of the
gallbladder and difficulties in dissection of the cystic duct and artery or may be mild difficulties that could be overcomed with minimal rnaneovurs as in the difficulties in insufflation and trocar entry.