Mucosal stripping cholecystectomy as a novel bailout procedure when subtotal cholecystectomy is not feasible: a case report.

INTRODUCTION

Subtotal cholecystectomy is recommended when the critical view of safety cannot be achieved; however, in some "extremely difficult gallbladder" cases, dense adhesions make even subtotal resection unsafe. In such situations, few safe operative options exist. We report a case in which laparoscopic mucosal stripping cholecystectomy was performed as a bailout option.

PRESENTATION OF CASE: A 72-year-old man receiving prednisolone for IgG4-related disease presented with recurrent cholecystitis. Preoperative computed tomography revealed gallbladder distension and marked wall thickening, suggesting a difficult gallbladder. Intraoperatively, dense adhesions between the anterior wall of the gallbladder and the hepatoduodenal ligament prevented safe neck dissection and limited the feasibility of standard subtotal cholecystectomy. After fenestration of the fundus, gentle traction allowed continuous stripping and removal of the gallbladder mucosa up to the neck. The residual gallbladder wall was coagulated, and a drain was placed. The postoperative course was uneventful, and no recurrence was observed for more than 2 years.

DISCUSSION: Subtotal cholecystectomy aims to eliminate gallbladder function rather than its anatomical presence. As gallbladder physiology is primarily mediated by its mucosal lining, mucosal removal can be considered the true operative endpoint. Residual mucosa has been associated with postoperative biliary events and reintervention in subtotal cholecystectomy. Therefore, mucosal stripping offers a minimal yet sufficient approach when safe dissection planes are lost.

CONCLUSION

Mucosal-stripping cholecystectomy may serve as a simple, safe, and effective bailout procedure when even subtotal cholecystectomy is technically difficult.