BACKGROUND Laparoscopic cholecystectomy is the standard of care for symptomatic gallstone disease but when laparoscopic removal proves impossible the standard advice is to convert to open surgery. This jettisons the advantages of laparoscopy for a procedure which surgeons no longer perform routinely, so it may no longer be the safest practice. We hypothesised that gallbladder aspiration would be a safer alternative when laparoscopic removal is impossible. METHODS A retrospective analysis was performed of all laparoscopic cholecystectomies attempted under one surgeon's care over 19 years, and the outcomes of gallbladder aspiration were compared with the standard conversion-to-open procedure within the same institution. RESULTS Of 757 laparoscopic cholecystectomies attempted, 714 (94.3%) were successful, while 40 (5.3%) were impossible laparoscopically and underwent gallbladder aspiration. Interval cholecystectomy was later performed in 34/40 (85%). Only 3/757 (0.4%) were converted to open. No aspiration-related complications occurred and excessive bile leakage from the gallbladder was not observed. During this time 1209 laparoscopic cholecystectomies were attempted by other surgeons in the institution of which 55 (4.55%) were converted to open and 22 (40%) had procedure-associated complications. There was a significant difference in the mean (± SEM) post-operative hospital stay between laparoscopic gallbladder aspiration [3.12 (± 0.558) days] and institutional conversion-to-open cholecystectomy [9.38 (± 1.04) days] (p < 0.001), with attendant cost savings. CONCLUSION Laparoscopic gallbladder aspiration is a safe alternative to conversion when inflammation makes cholecystectomy impossible laparoscopically, especially in the sickest patients and for surgeons with limited open surgery experience. This approach minimises morbidity and permits laparoscopic cholecystectomy in the majority after a suitable interval or referral of predicted difficult cases to specialist hepatobiliary centres.

中文翻译：

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不可能的胆囊：作为转换的替代方案的愿望。

背景技术腹腔镜胆囊切除术是治疗症状性胆结石病的标准治疗方法，但当腹腔镜切除术证明不可能时，标准建议是转为开腹手术。这放弃了腹腔镜手术的优势，外科医生不再常规进行手术，因此它可能不再是最安全的做法。我们假设当腹腔镜切除不可能时，胆囊抽吸将是一种更安全的选择。方法 回顾性分析一名外科医生在 19 年内尝试进行的所有腹腔镜胆囊切除术，并将胆囊抽吸的结果与同一机构内的标准中转开放手术进行比较。结果 757 例腹腔镜胆囊切除术中，714 例（94.3%）成功，40 例（5. 3%) 无法通过腹腔镜检查并进行胆囊抽吸。后来在 34/40 (85%) 中进行了间隔胆囊切除术。只有 3/757 (0.4%) 转换为开放式。没有发生与误吸相关的并发症，也没有观察到胆囊中过多的胆汁泄漏。在此期间，该机构的其他外科医生尝试了 1209 例腹腔镜胆囊切除术，其中 55 例（4.55%）中转开腹，22 例（40%）出现手术相关并发症。腹腔镜胆囊抽吸术 [3.12 (± 0.558) 天] 和机构中转开腹胆囊切除术 [9.38 (± 1.04) 天] 的平均 (± SEM) 术后住院时间存在显着差异 (p < 0.001) ，随之而来的成本节约。结论 当炎症使腹腔镜胆囊切除术无法进行时，腹腔镜胆囊抽吸术是一种安全的替代方法，特别是对于病情最严重的患者和开放手术经验有限的外科医生。这种方法可以最大限度地减少发病率，并允许在适当的间隔或将预测的困难病例转诊到专科肝胆中心后进行腹腔镜胆囊切除术。