Dissection of the gallbladder from the liver bed during laparoscopic cholecystectomy for acute or subacute cholecystitis

Current literature suggests that early laparoscopic cholecystectomy (LC) for acute cholecystitis (AC) can be safely performed within 72 h of symptom onset. However, for various reasons, in clinical practice, fibrosed gallbladders are frequently encountered during early LC for AC. The subserosal layer of the gallbladder wall can be divided into an inner and an outer layer. The inner layer has an abundant vasculature and some fibrous tissue; it abuts the muscularis propria. The outer layer consists of abundant fat tissue; it abuts the serosa or the liver parenchyma. In both patients with AC and those without cholecystitis, dissection of the gallbladder in the outer layer facilitates removal of the gallbladder without tearing the gallbladder or injuring the liver parenchyma behind the liver bed. However, in patients with AC lasting 72 h or more, the subserosal layer becomes solid and thick due to inflammatory cell infiltration and fibrotic change. Thus, adequate dissection of the outer layer becomes difficult. However, there is a layer between the inner and outer layers that can be dissected bluntly and easily. Thus, we could dissect the gallbladder from its liver bed safely, surely, and quickly by using our original technique which was validated by histological examination.