Description

Laparoscopic cholecystectomy remains the gold standard for the management of gallbladder stones, but certain anatomical variations can transform a routine surgery into a challenging operative experience. One such case was recently managed at World Laparoscopy Hospital, where a patient presented with a long gallbladder and an impacted cystic duct stone, making dissection and identification of structures unusually complex. Clinical Presentation and Diagnosis The patient presented with classical symptoms of biliary colic and intermittent upper abdominal pain. Ultrasonography revealed a distended, elongated gallbladder extending close to the midline, along with a large calculus lodged in the cystic duct. The elongated anatomy and ductal obstruction hinted at potential operative challenges. Operative Approach The laparoscopic cholecystectomy was performed under general anesthesia using a standard four-port technique. Upon entry into the peritoneal cavity, the gallbladder appeared unusually long and partially embedded within the hepatic parenchyma. The infundibulum was tense, and the cystic duct was thickened due to the impacted stone. Dissection in Calot’s triangle required meticulous step-by-step precision. The surgical team, led by Dr. R. K. Mishra, emphasized achieving the Critical View of Safety (CVS) before clipping or cutting any structure. Advanced laparoscopic instruments such as Maryland dissectors and hook cautery were employed to gently separate fibrotic tissues without injuring nearby structures like the common bile duct. Challenging Steps The major challenge was exposing the cystic duct while avoiding injury to the common hepatic duct. The stone’s impaction caused ductal shortening and dense adhesions. The team opted to milk the stone back toward the gallbladder neck, followed by a small cysticotomy to extract it safely. After removal, the cystic duct was clearly visualized, clipped, and divided securely. Outcome and Recovery The gallbladder was successfully retrieved using an endobag to prevent spillage. The patient recovered smoothly and was discharged within 24 hours. Postoperative follow-up showed no bile leak or residual ductal stone. Learning Highlights This case underscores the importance of: Recognizing anatomical variations such as a long gallbladder or an aberrant cystic duct. Maintaining gentle traction and counter-traction to expose Calot’s triangle. Prioritizing Critical View of Safety to prevent bile duct injuries. Utilizing laparoscopic finesse and patience rather than forceful dissection in complex cases. Conclusion At World Laparoscopy Hospital, where surgeons are trained in the art and science of minimal access surgery, even challenging cases like a long gallbladder with a cystic duct stone are handled with skill and safety. This case reaffirms the hospital’s reputation as a global center of excellence for advanced laparoscopic procedures and surgical education—where every dissection teaches precision, patience, and professional mastery.