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Abstract
Gallbladder disease is the most common of all digestive disorders requiring hospitalization, and cholecystectomy is the most common abdominal operation undertaken, with 500,000 operations annually in the USA. Gallstones are often asymptomatic, increasing in prevalence with age. At 60 years of age about 30% of women and about 15% of men in European populations have gallstones. Carl Langenbuch realized in Germany in 1882, the first cholecystectomy. On this century of experience, the technique has been converted in a classic way. Since 1910, it was converted on the gold standard in the treatment of the cholelithiasis, place that it still conserves. With the apparition of the endoscopy techniques, and the minimum access idea, the way of carrying it out has changed. (Salky et al., 2003).
Today the removal of the gallbladder is the safest, the most effective and widely recommended treatment for gallstone disease. (Laws et al., 1999). Since the introduction of laparoscopic cholecystectomy into general practice in 1990, it has rapidly become the gold standard for symptomatic cholelithiasis, while open cholecystectomy is now reserved for difficult and problematic cases. (Robert et al., 2000).
The difficult gallbladder is the most common ”difficult” laparoscopic surgery performed by general surgeons. It is also ”potentially” the one that places the patient at significant risk, so nearly all surgeons will encounter difficult cholecystectomies.