Acute Cholecystitis & Difficult Gallbladder: Bailout & BDI Prevention

The field of hepatobiliary surgery has seen significant developments in the management of acute cholecystitis and technically challenging gallbladders. Acute cholecystitis remains a common cause for emergency surgery and continues to pose risks for severe complications, particularly in cases of severe inflammation, anatomical anomalies, or dense adhesions. One of the principal concerns in these scenarios is the heightened risk of bile duct injury (BDI), a complication that can result in substantial patient morbidity and long-term consequences. Recent literature has underscored the ongoing debates around the timing of intervention, the balance of laparoscopic versus open approaches, and the identification of optimal bailout strategies, such as subtotal cholecystectomy, when a critical view of safety cannot be achieved. Despite advancements in imaging, intraoperative assessment, and surgical technique, the field still lacks consensus on standardized guidelines for when and how to deploy alternative approaches, and evidence on long-term outcomes following bailout or damage control procedures remains limited.This Research Topic aims to explore current and emerging operative strategies for difficult gallbladder disease, with a special emphasis on bailout procedures and the prevention of bile duct injury. The objective is to provide a comprehensive synthesis of evidence, share surgical innovations, and foster discussion on technical decision-making. Specific questions to be addressed include: What criteria should guide the shift to bailouts such as subtotal cholecystectomy? Are there new techniques or technologies - including fluorescence-guided approaches and AI-driven analytics - that enhance intraoperative safety? How can preoperative risk stratification and complication management protocols be optimized to mitigate both immediate and delayed risks?To gather further insights in the operative and perioperative management of acute cholecystitis and difficult gallbladder cases, we welcome articles addressing, but not limited to, the following themes:o Techniques and innovations in bailout procedures (e.g., subtotal cholecystectomy, fundus-first approach);o Decision-making processes for conversion or alternative strategies;o Preoperative and intraoperative risk stratification, including scoring systems;o Timing and indications for surgery in acute cholecystitis;o Methods for intraoperative identification and prevention of bile duct injury;o Management of complications and outcomes after difficult cholecystectomy;o Use of intraoperative imaging and adjunct technologies, including fluorescence-guided surgery with indocyanine green (ICG);o Integration of artificial intelligence and predictive analytics in surgical planning and outcomes;o Protocols for postoperative care and patient follow-up.Suitable article types include, but are not limited to, original research, clinical studies, reviews, brief reports, and case series. Topic editors: Antonio Zanghi, Lovenish Bains, Vincenzo Neri Source: https://www.frontiersin.org/research-topics/81056/acute-cholecystitis-difficult-gallbladder-bailout-bdi-prevention