Laparoscopic subtotal cholecystectomy: a safe approach in difficult cholecystectomy
Keywords:Laparoscopic cholecystectomy, Laparoscopic retrograde cholecystectomy, Laparoscopic subtotal cholecystectomy
Background: Laparoscopic cholecystectomy (LC) has been recognized as the new "gold standard" for the treatment of symptomatic gallstone disease. In order to prevent serious bile duct and vascular injuries, conversion is advocated for unclear anatomy at the Calot’s. Our aim was to assess the safety and effectiveness of laparoscopic subtotal cholecystectomy (LSC) in difficult cholecystectomy in order to reduce the incidence of bile duct injury and conversion rates.
Methods: An analysis of retrospectively collected data of 452 patients who underwent LC was done at our Hospital during the period of January 2010 to December 2013. In few cases of difficult GB when Calot’s could not be dissected, laparoscopic retrograde cholecystectomy (LRC) was attempted and if that failed we adopted the technique of LSC.
Results: A total of 452 patients were included. The median age was 48 years. All the 452 patients were posted for LC. Of the 452 patients, 404 patients underwent LC and the remaining 48 patients had difficult GB. Among the 48 patients having a difficult GB, 44 cases underwent LSC (3 cases underwent LSC Type-1 and 41 cases underwent LSC Type-2) and the remaining 4 cases underwent conversion to open cholecystectomy. The mean operative time was 130mins and median post op stay was 2 days.
Conclusions: In our technique of LSC the conversion rates were <1% with no bile duct injury and believe that it is feasible and safe for operating on difficult GB’s.
Soper NJ, Brunt LM, Callery MP, Edmundowicz SA, Aliperti G. Role of laparoscopic cholecystectomy in the management of acute gall stone pancreatitis. Am J Surg. 1994;167(1):42-50.
Blum CA, Adams DB. Who did the first laparoscopic cholecystectomy? J Minim Access Surg. 2011;7:165-8.
Manson J. Bile duct injury in the era of laparoscopic cholecystectomy. Br J Surg. 2006;93:158-68.
Philips JA, Laws DA, Cook AJ, Arulampalam TH, Zaborsky A, Menzies D, et al. The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc. 2008;22:1697-700.
Davis B, Castaneda G, Lopez J. subtotal cholecystectomy versus total cholecystectomy in complicated cholecystitis. Am Surg. 2012;78:814-7.
Tamura A, Ishii J, Katagiri T, Maeda T, Kubota Y, Kaneko H. Effectiveness of laparoscopic subtotal cholecystectomy: perioperative and long term postoperative results. Hepatogastroenterol. 2013;60:1280-3.
Sanabria JR, Clavien PA, Cywes R, Strassberg SM. Laparoscopic versus open cholecystectomy: A matched study. Can J Surg. 1993;36:330-6.
Beldi G, Glattli A. Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc. 2003;17:1437-9.
Chowbey PK, Sharma A, Khullar R, Mann V, Baijal M, Vashistha A. laparoscopic subtotal cholecystectomy:a re-view of 56 procedures. J Laparoendosc Adv Surg Tech A. 2000;10:31-4.
Palanivelu C. Art of Laparoscopic Surgery Textbook and Atlas (2 Vols.). Jaypee Brothers Publishers; 2005:647-656.
Gode D, Palanivelu C, Syed ZQ. New variants of laparoscopic subtotal cholecystectomy in management of acute cholecystitis. Int J Med Science Pub Healh. 2014;3(4):397-401.
Cottier DK, McKay C, Anderson JR. Subtotal cholecystectomy. Br J Surg. 1991;78:1326-8.
wolf AS, Nijsse BA, Sokal SM, Chang Y, Berger DL. Surgical outcomes of open cholecystectomy in the laparo-scopic era. Am J Surg. 2009;197:781-4.
Bingener-Casey J, Richards ML, Strodel WE, Schwesinger WH, Sirinek KR. Reasons for conversion from laparoscopic to open cholecystectomy: a 10-year review. J Gastrointest Surg. 2002;6:800-5.
Lo CM, Liu CL, Fan ST, Lai EC, Wong J. Prospective randomized study of early versus delayed laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1998;227:461-7.
Deziel DJ, Millikan KW, Economu SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystec-tomy: A national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg. 1993;165:9-14.
Strassberg SM. Error traps and vasculo-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg. 2008;15:284-92.
Philips JA, Lawes DA, Cook AJ, Arulampalam TH, Zaborsky A, Menzies D, et al. The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc. 2008;22:1697-700.
Ouchi K, Mikuni J, Kakugawa Y, Organizing Committee of the 30th Annual Congress of the Japanese Society of Biliary Surgery Laparoscopic cholecystectomy for gallbladder carcinoma: results of a Japanese survey of 498 patients. J Hepatobiliary Pancreat Surg. 2002;9:256-60.
Yamamoto H, Hayakawa N, Kitagawa Y, Katohno Y, Sasaya T, et al. Unsuspected gallbladder carcinoma after laparoscopic cholecystectomy. J Hepatobillary Pancreat Surg. 2005;12:391-8.
Chuang SC, Lee KT, Chang WT, Wang SN, Kuo KK, Chen JS, et al. Risk factors for wound infection after chole-cystectomy. J Formos Med Assoc. 2004;103:607-12.