When the gallbladder turns hostile, sometimes you must do more than just pause—you have to call in a senior partner for help. Join the Behind the Knife EGS team at Mizzou as we dive into the art and grit of open cholecystectomy. From fundus-first dissection to navigating the “barrier to happiness,” this episode is packed with surgical pearls, tough love, and the kind of wisdom only scars can teach.
Participants:
Learning Objectives:
·
Recognize Indications for Conversion
Identify clinical and intraoperative factors that necessitate conversion from laparoscopic to open cholecystectomy.
·
Apply Risk Stratification Tools
Utilize grading systems (e.g., Parkland, Tokyo, AAST) to assess cholecystitis severity and predict surgical difficulty.
·
Implement Safe Cholecystectomy Techniques
Describe the six steps of the SAGES Safe Cholecystectomy Program to minimize bile duct injury.
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Understand Bailout Strategies
Differentiate between fenestrating and reconstituting subtotal cholecystectomy techniques and their respective risks.
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Master Key Operative Steps
Outline the essential components of open cholecystectomy: positioning, incision, exposure, and dissection.
·
Navigate High-Risk Anatomy
Recognize “zones of danger” and use the B-SAFE mnemonic to reorient and ensure safe progression.
·
Develop Intraoperative Judgment
Demonstrate when to proceed with subtotal techniques, convert to open, or call for assistance.
·
Perform Technical Nuances Safely
Identify proper dissection planes, manage gallbladder bed inflammation, and secure cystic structures with confidence.
·
Prevent and Manage Complications
Understand the risks of bile leaks, bilomas, and subcostal hernias—and how to mitigate them through technique and closure.
·
Foster Surgical Maturity
Emphasize humility, collaboration, and mentorship in difficult operations—knowing when to ask for help is a skill.
References:
1. Dhanasekara, C. S., Shrestha, K., Grossman, H., Garcia, L. M., Maqbool, B., Luppens, C., ... & Dissanaike, S. (2024). A comparison of outcomes including bile duct injury of subtotal cholecystectomy versus open total cholecystectomy as bailout procedures for severe cholecystitis: A multicenter real-world study.
Surgery, 176(5), 605–613.
https://doi.org/10.1016/j.surg.2024.03.057
2. Motter, S. B., de Figueiredo, S. M. P., Marcolin, P., Trindade, B. O., Brandao, G. R., & Moffett, J. M. (2024). Fenestrating vs reconstituting laparoscopic subtotal cholecystectomy: A systematic review and meta-analysis.
Surgical Endoscopy, 38, 7475–7485.
https://doi.org/10.1007/s00464-024-11225-8
3. Brunt, L. M., Deziel, D. J., Telem, D. A., Strasberg, S. M., Aggarwal, R., Asbun, H., ... & Stefanidis, D. (2020). Safe chole
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