The difficult gallbladder: Technical tips for laparoscopic cholecystectomy

Conversion of laparoscopic cholecystectomy to laparotomy may increase posto perative complications and convalescence and should therefore be avoided wh en possible. The authors present three technical rips that may prevent unne cessary conversion to open procedure (suspension sutures in the gallbladder , use of the Endo Paddle Retract (United States Surgical Corp., Norwalk, CT , USA) to depress abdominal viscera, and subtotal cholecystectomy). These m ethods may be used in situations in which there is no operative risk for co mplications, such as bile duct injury, but technical aspects of the operati on normally would have resulted in conversion to laparotomy.