DOI: https://doi.org/10.36347/sasjs.2025.v11i10.014

Pages: 1009-1013

Background: Laparoscopic cholecystectomy (LC) is the gold standard treatment for gallstone disease worldwide. Despite being a routine operation for most surgeons, it can become technically challenging because of dense adhesions, abnormal biliary anatomy, or gallbladder inflammation. Meticulous dissection is required to establish critical view of safety. Safe dissection is the key to complete laparoscopic cholecystectomy successfully and to prevent complications, such as bile duct injury. This study aimed to identify the intraoperative difficulties encountered during LC and describe the effective techniques employed to overcome them. Methods: This retrospective study was conducted at a tertiary hospital over a period of 12 months (October 2020 to October 2021). All patients underwent a standard four-port laparoscopic cholecystectomy. Various intraoperative difficulties were identified and overcome using different techniques. Results: Of the 27 laparoscopic cholecystectomies performed, 12 (44.44%) were smooth and 15 (55.55%) were difficult. However, none of the patients required conversion to open surgery. Various difficulties encountered were: problem in creating pneumoperitoneum in one (3.7%) patient, dense adhesion in seven (25.93%) patients, abnormal Callot’s anatomy and difficult cystic duct and artery skeletonization in three (11.11%) patients, inability to grasp the fundus of the gallbladder in two (7.41%) patients, difficulty in separating the gallbladder in one (3.7%) patient, and difficult extraction of the gallbladder containing multiple large stones through the umbilical port in one (3.7%) patient. Conclusion: Early identification of Rouviere’s sulcus, precise posterior dissection, and careful handling of the cystic duct and artery are critical for managing intraoperative complications. Adherence to these technical refinements ensures safety and reduces the need for conversions.