A Challenging Case of Laparoscopic Cholecystectomy: Acute on Chronic Fibrotic Cholecystitis; Gallbladder Hydrops

This video presents a challenging laparoscopic cholecystectomy in a patient with acute-on-chronic cholecystitis associated with gallbladder hydrops. Recurrent inflammation resulted in a markedly thickened and fibrotic gallbladder wall with dense adhesions to the liver bed and surrounding structures, obscuring normal anatomical landmarks. Hydrops of the gallbladder caused significant distension, limiting grasping, traction, and adequate exposure of Calot’s triangle. Edema and fibrosis increased the risk of bleeding and bile duct injury during dissection. Careful decompression of the gallbladder and slow, methodical adhesiolysis were essential to restore orientation. Dissection was deliberately kept close to the gallbladder wall to minimize the risk of common bile duct injury. This case demonstrates the technical difficulties and the importance of surgical judgment and adherence to safety principles in complex laparoscopic cholecystectomy.