Laparoscopic cholecystectomy is the gold standard for gallstone disease. But when a high grade of inflammation is present, the identification of the bile duct, the cystic duct, and the cystic artery became difficult. In this case, conversion to open surgery represents a good option for the safety of the patient. Two techniques for open surgery in case of difficult cholecystectomy are reported in the literature: partial and subtotal cholecystectomy. All the evolutive surgical steps adopted for this technique in the last centuries, all the algorithms to anticipate the conversions from laparoscopy, actual surgical techniques, and complications are reported in the present chapter.
