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Difficult laparoscopic cholecystectomy is associated with increased operative time, hospital stay, complication rates, open conversion, treatment costs, and mortality. This study aimed to provide a comprehensive literature review on difficult laparoscopic cholecystectomy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>A literature search was conducted for articles published in English up to June 2024 using common databases including PubMed\/MIDLINE, Web of Science, Google Scholar, and ScienceDirect. Keywords included \u201csafe laparoscopic cholecystectomy\u201d, \u201cdifficult laparoscopic cholecystectomy\u201d, \u201cacute cholecystitis\u201d, \u201cprevention of bile duct injuries\u201d, \u201cintraoperative cholangiography,\u201d \u201cbailout procedure,\u201d and \u201csubtotal cholecystectomy\u201d. Only clinical trials, systematic reviews\/meta-analyses, and review articles were included. Studies involving children, robotic cholecystectomy, single incision laparoscopic cholecystectomy, open cholecystectomy, and cholecystectomy for indications other than gallstone disease were excluded.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results\/discussion<\/jats:title>\n            <jats:p>Emergency laparoscopic cholecystectomy for acute cholecystitis is ideally performed within 72\u00a0h of symptom onset, with a maximum window of 7\u201310 days. Intraoperative cholangiography can help clarify unclear biliary anatomy and detect bile duct injuries. In the \u201cimpossible gallbladder\u201d, laparoscopic cholecystostomy or gallbladder aspiration may be considered. When dissection of Calot\u2019s triangle is deemed hazardous or impossible, the fundus-first approach allows for completion of the procedure with either total cholecystectomy or subtotal cholecystectomy. Subtotal cholecystectomy is effective in preventing bile duct injuries, can be performed laparoscopically, and is currently the best available bailout approach for difficult laparoscopic cholecystectomy.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>Difficult laparoscopic cholecystectomy is a common clinical scenario that requires a judicious approach by experienced surgeons in appropriate settings. When difficult laparoscopic cholecystectomy is encountered, various bailout strategies are available. Currently, subtotal cholecystectomy is likely the most effective bailout approach.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12893-025-02847-3","type":"journal-article","created":{"date-parts":[[2025,4,12]],"date-time":"2025-04-12T08:57:41Z","timestamp":1744448261000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":48,"title":["The difficult laparoscopic cholecystectomy: a narrative review"],"prefix":"10.1186","volume":"25","author":[{"given":"Hamdy S.","family":"Abdallah","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamad H.","family":"Sedky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zyad H.","family":"Sedky","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,4,12]]},"reference":[{"key":"2847_CR1","first-page":"69","volume":"9","author":"J Blythe","year":"2018","unstructured":"Blythe J, Herrmann E, Faust D, Faust D, Falk S, Edwards-Lehr T, Stockhausen F, et al. 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