Korean J Hepatobiliary Pancreat Surg.  2011 Nov;15(4):225-230. 10.14701/kjhbps.2011.15.4.225.

Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis

• Jeong IO
• Kim JY
• Choe YM
• Choi SK
• Heo YS
• Lee KY
• Kim SJ
• Cho YU
• Ahn SI
• Hong KC
• Kim KR
• Shin SH

• KMID: 2244129
• DOI: http://doi.org/10.14701/kjhbps.2011.15.4.225

Abstract

BACKGROUNDS/AIMS
For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility.
METHODS
In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed.
RESULTS
There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p<0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren't any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p<0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p<0.001).
CONCLUSIONS
LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery.

Keyword

Acute cholecystitis; Laparoscopic subtotal cholecystectomy

MeSH Terms

Bile
Bile Ducts
Cholecystectomy
Cholecystectomy, Laparoscopic
Cholecystitis, Acute
Conversion to Open Surgery
Diet
Hemorrhage
Humans
Liver
Operative Time
Tokyo

Figure

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  Fig. 1 Illustration of the surgical technique. The gallbladder infundibular serosa dissected and the cystic duct was clipped twice. The anterior wall of the gallbladder was dissected and mucosa of the remnant posterior wall was destroyed.

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