Surgical Outcomes Following Fluorescence Cholangiography-Guided Laparoscopic Cholecystectomy in Patients with Moderate Acute Cholecystitis

Abstract In patients with moderate acute cholecystitis, there is an increased risk of iatrogenic bile duct injury during laparoscopic cholecystectomy. Fluorescence cholangiography (FC) can improve visualisation of extra hepatic bile ducts intra-operatively and can assist in achieving critical view of safety (CVS) principles. The present prospective observational study focuses on the efficacy of FC with indocyanine green (ICG) in patients with moderate acute cholecystitis who underwent laparoscopic cholecystectomy at our department between October 2021 and April 2024. We compared visualisation rates of extrahepatic bile ducts, both before and after achieving CVS along with FC-ICG. We were also interested in the post-operative surgical outcomes. Descriptive statistics were used to present our results. In our cohort of 33 patients (52% female) with moderate acute cholecystitis, the acute gangrenous subtype (56.2%) was the most common followed by the acute phlegmonous form (43.8%). The median operative time was 85 minutes with three patients requiring conversion to an open approach. When comparing before and after CVS achievement, FC-ICG improved the visualisation of extrahepatic biliary tree structures including the cystic duct (52% vs 70%), common bile duct (48% vs 70%), and common hepatic duct (33% vs 46%). Median hospitalisation duration was six days with no patient reporting any post-operative complications. Consequently, the median post-operative patient well-being score was 80%. FC-ICG improves the visualisation of extrahepatic biliary tree structures during laparoscopic cholecystectomy in patients with acute moderate cholecystitis, thereby increasing success rates and reducing complication rates.