Laparoscopic cholecystectomy in a patient with sickle cell disease and acquired cranial gallbladder malposition: technical adaptations to achieve safe dissection

Abstract We report the case of a 38-year-old male with sickle cell disease (SCD) who underwent elective laparoscopic cholecystectomy for recurrent biliary colic. Intraoperative exploration revealed a rare acquired cranial gallbladder malposition, with the gallbladder lying high in the subdiaphragmatic space and displaced posteriorly, in the setting of marked hepatomegaly and chronic inflammation. This abnormal positioning resulted in significant exposure limitations and difficulty achieving the classical critical view of safety. Conventional fundal traction was ineffective. Adequate exposure was ultimately achieved through direct retraction of the right hepatic lobe via the epigastric trocar, combined with surgeon repositioning and modified use of existing ports. The procedure was completed laparoscopically without conversion to open surgery or complications. This case highlights the importance of recognizing acquired gallbladder malposition as a cause of difficult cholecystectomy and underscores the need for adaptable operative strategies to achieve safe dissection.