Colecistectomía laparoscópica difícil: una revisión del estado del arte

Abstract

Introduction. In Latin America, it is reported that gallstone disease affects between 8.9% and 27.7% of individuals during adulthood. Regarding Ecuador, the prevalence of cholelithiasis is estimated at 10%, being more common in women and individuals over 50 years old.

Objective. To define difficult laparoscopic cholecystectomy.

Methodology. This research was conducted through a literature review, also known as a narrative review, allowing the collection and analysis of quality information from various high-impact databases.

Results. Difficult laparoscopic cholecystectomy faces challenges arising from anatomical and pathological conditions, such as adhesions, anomalous biliary anatomy, and large stones. Risks include obesity, previous surgeries, and acute gallbladder inflammation. Surgical strategies encompass alternative approaches, cholecystolithotomy, and specialized tools. Evaluation of studies indicates variability in efficacy and safety. Technological advances, like robotic surgery and advanced imaging techniques, are influencing practice. Identifying risks, adapting approaches, and considering technology hold promise to enhance planning and outcomes in this complex surgery.

Conclusion. Difficult laparoscopic cholecystectomy confronts challenges rooted in specific anatomical and pathological conditions. Reviewing surgical strategies and techniques, coupled with assessing their efficacy and safety, provides a solid foundation for informed decision-making in clinical practice. Recognizing recent technological and surgical advancements underscores the need for ongoing adaptation to medical and surgical evolution. Ultimately, these conclusions support the necessity for an individualized, evidence-based approach in difficult laparoscopic cholecystectomy, aiming to optimize outcomes and ensure patient safety.