Outcome of Bailout Techniques in Non-achievement of Critical View of Safety during Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy (LC) is one of the most commonly performed surgical procedures. It has become the gold standard treatment for gall bladder diseases. But with the growing number of surgeries chances of intraoperative complications increase. Unfortunately, since the widespread use of the laparoscopic technique, the incidence of bile duct injury remains 0.3 -- 0.8%, compared to 0.2% in open operations. This leads to different types of bailout surgeries for the safety of patients. This study is done to evaluate the outcome of bailout techniques used in difficult laparoscopic cholecystectomies when critical view of safety (CVS) cannot be achieved.
Methods: This was an observational study conducted in General Surgery Department of Kathmandu Model Hospital and Kirtipur Hospital, Kathmandu, Nepal. All participants admitted for laparoscopic cholecystectomy were included in this study. Participants who had difficult laparoscopic cholecystectomy (DLC) were identified based non achievement of CVS. Demographic profile, indications, risk factors, intraoperative findings and bailout techniques were evaluated. 
Results: A total of 273 cases were included and analyzed in the study. The incidence of difficult LC was 41(15.01%). Types of Bailouts out techniques done were Fundus First, Sub-total cholecystectomy and open cholecystectomy. An overall conversion rate of LC to open cholecystectomy in difficult LC was seen in 3 (1.09%) of the cases. Intraoperative complications were not seen in 87.8% of the patients. All the patients with bailout techniques had excellent outcomes. The mean duration of hospital stay in difficult LC cases was five days.
Conclusion: Different bailout techniques during difficult Laparoscopic Cholecystectomy have excellent outcomes and are recommended to practice.