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| Name | Giant Gallbladder: Challenges and Conversion to Open Surgery – A Case Report from WALS 2025 |
| Video Uploader | Video From Dr. R. K. Mishra |
| Upload Date | This Video Uploaded At 01-03-2025 18:22:07 |
| Video Discription | Giant Gallbladder: Challenges in Laparoscopic Management and the Need for Conversion to Open Surgery – A Case Report from WALS 2025 Abstract Gallbladder diseases, particularly cholelithiasis and cholecystitis, are commonly managed using laparoscopic cholecystectomy. However, extreme cases such as a giant gallbladder pose significant technical challenges. We present a case where laparoscopic cholecystectomy was initiated but necessitated conversion to open surgery due to anatomical and surgical difficulties. This case was presented at WALS 2025, highlighting the complexities of minimally invasive surgery in such rare presentations. Introduction Laparoscopic cholecystectomy has become the gold standard for treating gallbladder disease. However, in rare cases of giant gallbladders, the minimally invasive approach may prove difficult due to anatomical distortion, adhesions, or excessive gallbladder distension. This report discusses a case where initial laparoscopic intervention was attempted but was converted to open surgery due to intraoperative challenges. Case Presentation A 52-year-old female presented with complaints of progressive right upper quadrant pain and abdominal distension. Ultrasound and MRI revealed an enlarged gallbladder measuring 25 cm in length, extending beyond the right iliac fossa, with multiple large gallstones. The patient had no history of previous abdominal surgery but had intermittent jaundice and dyspepsia. Surgical Approach A laparoscopic cholecystectomy was planned. • Ports Placement: A supraumbilical camera port and two ipsilateral working ports were placed. • Initial Findings: A massively distended gallbladder with severe adhesions to the liver and duodenum. • Challenges Faced: • Limited working space despite decompression. • Risk of bile spillage and iatrogenic injury. • Difficulty in identifying Calot’s Triangle due to inflammation. • Decision to Convert to Open Surgery: • Due to poor visibility and dense adhesions, a right subcostal incision was made. • The gallbladder was carefully dissected from the surrounding structures, ensuring bile duct integrity. • The procedure was completed successfully, and a drain was placed in the subhepatic space. Discussion Giant gallbladders are rare and often associated with chronic cholecystitis, malignancy, or congenital anomalies. While laparoscopic surgery remains the preferred approach, certain challenges warrant conversion to open surgery, including: • Severe adhesions making laparoscopic dissection hazardous. • Massive gallbladder distension, limiting visibility and maneuverability. • Risk of bile duct or vascular injury in cases with distorted anatomy. • Inability to safely achieve the critical view of safety (CVS). This case emphasizes that early decision-making in complex laparoscopic cases is crucial to prevent complications. While conversion to open surgery may seem like a step backward, it remains an important tool to ensure patient safety and a successful surgical outcome. Conclusion This case underscores the importance of adaptability in laparoscopic surgery. While the minimally invasive approach remains the first choice, timely conversion to open surgery is necessary in select cases to avoid complications. Surgeons must recognize the challenges posed by giant gallbladders and be prepared to alter the surgical plan when required. Would you like any modifications or additional details for publication in WJOLS? 🚀 |
| Category | Education |
| Tags | Giant gallbladder | laparoscopic cholecystectomy | conversion to open surgery | minimally invasive surgery | biliary surgery | surgical challenges | gallbladder distension | Calot’s Triangle | bile duct injury | chronic cholecystitis | gallstones | WALS 2025 | hepatobiliary surgery | laparoscopic complications | critical view of safety |
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