Subtotal Cholecystectomy for “Difficult Gallbladders”

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Abstract
Gallstone disease is a major health problem that affects 1% to 4% of the Western world population every year and almost 10% to 15% during their lifetime.1 This percentage corresponds to 6.3 million men and 14.2 million women aged 20 to 74 years in the United States.2 “Difficult gallbladder” (GB) is a procedure with an increased surgical risk compared with standard cholecystectomies.3,4 With an incidence of 16% (1 in 6) in a large series,3 difficult GB is usually associated with severe inflammation that distorts the local anatomy and renders dissections more difficult (ie, acute cholecystitis, empyema, gangrene, perforation, and Mirizzi syndrome) or with cirrhotic livers that increase the risk of bleeding. A scale was introduced by Nassar et al5,6 to score GB difficulty based on the GB status, cystic pedicle, and degree of adhesions. This scale graded cholecystectomies into 4 grades, with grades 3 and 4 being the most difficult.

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