Safe laparoscopic subtotal cholecystectomy in the face of severe inflammation in the cystohepatic triangle: a retrospective review and proposed management strategy for the difficult gallbladder

Roderick H. Purzner


We proposed 3 tenets as the foundation of the management of severe cholecystitis: early identification of a severely inflamed and possibly fused cystohepatic triangle resulting in a decision to avoid further dissection and prepare for Laparoscopic subtotal cholecystectomy; mobilization of the GB off of the liver bed in a counterclockwise direction well above the vasculobiliary pedicle using what we call the top-around technique; this is followed by opening of the GB at the level of Hartmann’s pouch and leaving a remnant without approaching the cystohepatic triangle at all; and removal of all stones from the GB remnant and identification of the cystic duct orifice to determine if there is bile leakage


Powered by

Need more features? Check out our Chrome Extension and save interactive summary cards to your Scholarcy Library.