Single-Port Laparoscopic Cholecystectomy in an Elderly Patient with Liver Cirrhosis: A Case Report

1. Background

Acute cholecystitis is a common surgical condition, particularly in elderly patients, and is frequently associated with gallstones. Advanced age and comorbidities such as liver cirrhosis may increase surgical complexity and perioperative risk. Minimally invasive approaches, including single-port laparoscopic cholecystectomy, can be challenging in such cases but may offer benefits in selected patients.

2. Patient Presentation

A woman in her late 70s presented with several days of abdominal pain accompanied by high fever. She initially visited a local clinic, where abdominal computed tomography (CT) was performed, leading to a diagnosis of acute cholecystitis. Due to the need for surgical management, she was referred to our institution.
At presentation, the patient had persistent abdominal pain and a body temperature exceeding 39°C.

3. Diagnostic Assessment

Contrast-enhanced abdominal CT demonstrated pericholecystic edema with inflammatory changes surrounding the gallbladder, consistent with acute cholecystitis.

Bedside ultrasonography performed by the surgeon revealed:
Pericholecystic infiltration with hazy inflammatory changes
Marked tenderness upon probe compression, consistent with a positive sonographic Murphy sign
These findings supported the diagnosis of acute cholecystitis.

4. Surgical Management

Date of surgery: June 23, 2025
Procedure: Single-port laparoscopic cholecystectomy
Length of hospital stay: 3 nights and 4 days

The procedure was performed through a single transumbilical incision. Intraoperatively, advanced liver cirrhosis was noted, with an irregular nodular surface of the liver. The gallbladder was located deep beneath the rib cage, making exposure and manipulation technically challenging in a single-port setting.

Despite these difficulties, careful dissection was performed. The cystic artery was identified and ligated first to improve visualization. The cystic duct was subsequently secured using clips and a Hem-o-lok device. The gallbladder was then dissected from the liver bed and removed without intraoperative complications.

5. Outcome and Follow-Up

Gross examination of the surgical specimen revealed gallstones with associated inflammatory changes. Histopathological analysis confirmed acute calculous cholecystitis.

Postoperatively, the patient recovered without complications. The umbilical incision showed minimal scarring on postoperative day one. She was discharged in stable condition on postoperative day three.

6. Discussion

Single-port laparoscopic cholecystectomy in elderly patients with severe inflammation and coexisting liver cirrhosis is technically demanding. Limited instrument triangulation and restricted visualization can increase procedural difficulty. However, with careful patient selection and meticulous surgical technique, this approach can be performed safely even in complex cases.
This case demonstrates that single-port laparoscopic cholecystectomy may be feasible in selected elderly patients with acute cholecystitis, despite unfavorable anatomical and inflammatory conditions.

7. Key Learning Points

Acute cholecystitis in elderly patients often presents with severe inflammation and systemic symptoms.
Liver cirrhosis can significantly increase the technical difficulty of laparoscopic surgery.
Single-port laparoscopic cholecystectomy can be successfully performed in selected high-risk patients by experienced surgeons.
Careful intraoperative strategy and precise dissection are essential to ensure safety in complex cases

This case is presented for educational purposes only.
All patient-identifying information has been removed.