The complicated gallbladder—is old-school treatment an alternative?

Since implementation of the laparoscopic approach for removal of the gallbladder in the early 90s, a shift in numbers from open cholecystectomy (OC) to laparoscopic cholecystectomy (LC) has been observed. Despite initial reservations, LC has become the most favoured technique in the past 3 decades. Consecutive technical improvements support this trend. Considering this development, the question regarding the relevance of OC nowadays inevitably arises. This study represents a literature review performed in PubMed. Laparoscopic cholecystectomy has evolved to be the leading technique for cholecystectomy. This technique has become well established in elective as well as in acute indications. However, concomitant to increasing numbers of performed LC, the proportion of performed OC is declining, leading to a decreasing expertise and a lack in training in OC nowadays. However, in complex situations, when the operation strategy has to be changed to maintain patient safety, conversion to OC is the most common strategy. Owing to past and current developments, open cholecystectomy can hardly be assumed to be common surgical knowledge anymore. Hence, OC as bail-out strategy in cases of intraoperative difficulties must be critically evaluated. From this point of view, alternative patient management and treatment concepts should be considered to maintain patient safety.