Implementation of a Bail-out Strategy in Difficult Laparoscopic Cholecystectomy

Background and objectives: Laparoscopic cholecystectomy is the standard treatment for benign gallbladder disease; however, difficult cases may increase the risk of biliary and vascular injury. This study evaluated surgical approach patterns and major injury rates after adoption of a structured bail-out approach.

Methods

This retrospective cohort study included adult patients who underwent cholecystectomy between Sep 2012 and Jul 2025. Patients were divided into a preimplementation period before Jun 2022 and a bail-out period from Jun 2022 to Jul 2025. Demographic characteristics, surgical approach, difficult cholecystectomy cases, and major bile duct or hepatic arterial injuries were analyzed.