MOJ
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Case Report Volume 14 Issue 2
Use of a laparoscopic linear stapler as a bailout strategy in difficult laparoscopic cholecystectomy
Alejandro Weber-Sanchez, Pablo Weber-Alvarez
Received: June 20, 2026 | Published: July 28, 2026
Citation: Weber-Sanchez A, Weber-Alvarez P. Use of a laparoscopic linear stapler as a bailout strategy in difficult laparoscopic cholecystectomy. MOJ Surg. 2026;14(2):69-73. DOI: 10.15406/mojs.2026.14.00316
Abstract
Background: Difficult laparoscopic cholecystectomy (LC) with
failure to obtain the Critical View of Safety (CVS) is associated with an
increased risk of bile duct injury (BDI) and often necessitates bailout
strategies.
Objective: To evaluate the role of laparoscopic linear staplers
(LLS) as a bailout strategy during difficult LC when CVS cannot be achieved,
focusing on prevention of major BDI (primary outcome) and on conversion to open
surgery, postoperative complications, and length of hospital stay (LOS)
(secondary outcomes).
Methods: A structured literature review was performed across PubMed/MEDLINE,
Scopus, Web of Science, Embase, the Cochrane Library, Dimensions, and
open-access databases. Studies published between January 2000 and July 2026 in
English or Spanish of adult patients undergoing difficult LC in which LLS were
used to control the cystic duct and/or complete a subtotal cholecystectomy as a
bailout in the setting of failed CVS or hostile Calot’s triangle. Data
extracted comprised patient characteristics, indications, operative technique,
stapler use, conversion, postoperative complications, and length of stay. Owing
to heterogeneity, a descriptive synthesis was undertaken.
Results: The review identified retrospective cohorts, case series, and technical
reports including patients with complex biliary pathology. LLS were most
commonly employed for dilated, short, or friable cystic ducts and for
reconstituting subtotal cholecystectomy. Across series, only one case of BDI
was attributable to LLS-assisted bailout. Selective LLS use was associated with
low conversion rates, acceptable overall complication rates, and LOS generally
comparable to or shorter than that observed after conversion to open surgery,
although bile leak, stone migration, and remnant gallbladder syndrome were
reported.
Conclusios: In selected patients with difficult LC and failed
CVS, LLS appear to be a useful bailout adjunct that may help preserve a
minimally invasive approach. However, current evidence is limited to
heterogeneous observational studies. LLS use should be restricted to
experienced surgeons within a broader strategy of safe bailout, pending
prospective multicenter studies with standardized outcome reporting.
Keywords: laparoscopic cholecystectomy; laparoscopic stapler; bailout surgery; critical view of safety; bile duct injury
©2026 Weber-Sanchez, et al. This is an open access article distributed under the terms of the, which permits unrestricted use, distribution, and build upon your work non-commercially.