Case of Difficult Laparoscopic Cholecystectomy - I Want to Hear From You, Your Opinion in This Case

Please prepare yourself to struggle during this expected difficult laparoscopic cholecystectomy; insert at least one 10 mm port, insert a piece of gauze for dissection and compression in addition to be used as a sump suction. Retrieval bag is better to be introduced early. All methods of dissection; blunt, sharp, hydro dissection, blunt with gauze, monopolar hook, bipolar diathermy may be used. 

If you know that this was a male patient, 60 yrs old, DM, Hypertensive, had a past history of endoscopy for stone Right ureter 20 yrs ago, ERCP was done for stone CBD 4 yrs ago, with no available data, his abdominal ultrasound revealed thick wall GB containing multiple variable sizes stones, CBD with normal caliber, 3mm,  ….

Now I want to know what’s the next step.

1.      Cholecystostomy.

2.      Subtotal reconstituting cholecystectomy.

3.      Subtotal fenestrating cholecystectomy.

4.      Laparoscopic Cholecystectomy.

5.      Convert to open cholecystectomy.

6.      Abort the procedure and referred to a tertiary hepatobiliary center.

7.      Call for help from a nearby available hepatobiliary specialist.

8.      No trial to do it except in a tertiary hepatobiliary center from the start.