Liver Pucker Sign as a Predictor of Difficult Laparoscopic Cholecystectomy

The liver pucker sign, a depression in the region of the gallbladder caused by chronic contractive inflammation, indicates a challenging laparoscopic cholecystectomy. A case series reports three instances where the pucker sign was discovered during surgery, suggesting it can be used to anticipate complications. This sign typically arises in cases of chronic cholecystitis with delayed cholecystectomy, potentially guiding surgeons to modify their approach to minimize the risk of biliary or vascular injury.