Zafar Ullah Khan.
Difficult Laparoscopic Cholecystectomy, Primum non nocere!.
Pak J Surg Jan ;38(1):3-7.

Cholecystectomy is one of the most commonly performed general surgical procedures and laparoscopic cholecystectomy is the standard of care for gallstones. A surgeon will often encounter difficult situations during cholecystectomy where decision-making is of vital importance and any wrong move can alter the course of surgery and consequently the patient`s life. Various pre-operative variables and intra-operative findings are used to predict and describe a difficult cholecystectomy. It is mandatory for the surgeon to perform a thorough pre-operative evaluation to identify a potentially difficult gallbladder by correlating a careful history and examination with laboratory and radiological findings. Pre-operative identification of a difficult cholecystectomy helps the surgeon to plan for difficult circumstances ahead of surgery and also to counsel the patient about it before taking consent. Laparoscopic cholecystectomy is not a simple procedure and must be performed with utmost carefulness and diligence. Conversion to open procedure must not be regarded as a failure or incompetence but as sound judgement instead to avert a potentially serious complication.

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