A Study of Combined Laparoscopic-Endoscopic Approach for Complex Cholecystic Disease in A Same Operative Session With 3 Ports Technique: A Safe Bailout Strategy

Background: Laparoscopic cholecystectomy is the gold standard for gallbladder disease. However, dense adhesions, severe inflammation, empyema, gangrene, impacted stones, choledocholithiasis and anatomical anomalies may render conventional laparoscopic cholecystectomy unsafe. Methodology: This is a retrospective observational study included 130 patients who underwent laparoscopic cholecystectomy or laparoscopic subtotal cholecystectomy between July 2012 and January 2025 at a tertiary referral centre. Preoperative evaluation included clinical assessment, laboratory investigations, ultrasonography in 100 (76.92%) or ultrasonography with magnetic resonance cholangiopancreatography in 30 (23.08%). Outcomes included operative details, postoperative recovery, complications and hospital stays. Statistical analysis utilized Chi-square test, Fisher’s exact test, Student’s t-test and one-way ANOVA with p < 0.05 considered significant. Results: Laparoscopic cholecystectomy was completed in 85 (65.38%), laparoscopic subtotal cholecystectomy was required in 43 (33.08%) and open conversion occurred in 2 (1.54%). Controlled bile leak developed in 53 (40.77%), resolving spontaneously in 35 (66.04%) within 15 to 21 days. Mean operative time was (2.14 ± 0.75) hours and mean hospital stay was (1.86 ± 1.0) days. Overall morbidity was 8 (6.15%), with complications including common bile duct stricture in 2 (1.54%), common bile duct injury in 1 (0.77%), hepatic artery injury in 1 (0.77%) and mortality in 1 (0.77%) from cardiac arrest unrelated to surgery. Conclusion: Laparoscopic cholecystectomy, including laparoscopic subtotal cholecystectomy with mucosectomy and endoscopic retrograde cholangiopancreatography with common bile duct stenting when indicated, is a safe and effective approach in both acute and chronic cholecystitis, even in complex gallbladder cases which are technically difficult cases.