Ann Surg Treat Res.  2016 Nov;91(5):226-232. 10.4174/astr.2016.91.5.226.

Clinical outcomes of subtotal cholecystectomy performed for difficult cholecystectomy

• Shin M
• Choi N
• Yoo Y
• Kim Y
• Kim S
• Mun S

• KMID: 2356372
• DOI: http://doi.org/10.4174/astr.2016.91.5.226

Abstract

PURPOSE
Laparoscopic subtotal cholecystectomy (LSC) can be an alternative surgical technique for difficult cholecystectomies. Surgeons performing LSC sometimes leave the posterior wall of the gallbladder (GB) to shorten the operation time and avoid liver injury. However, leaving the inflamed posterior GB wall is a major concern. In this study, we evaluated the clinical outcomes of standard laparoscopic cholecystectomy (SLC), LSC, and LSC removing only anterior wall of the GB (LSCA).
METHODS
We retrospectively reviewed the medical records of laparoscopic cholecystectomies performed between January 2006 to December 2015 and analyzed the outcomes of SLC, LSC, and LSCA.
RESULTS
A total of 1,037 patients underwent SLC. 22 patients underwent LSC; and 27 patients underwent LSCA. The mean operating times of SLC, LSC, and LSCA were 41, 74, and 68 minutes, respectively (P < 0.01). Blood loss was 5, 45, and 33 mL (P < 0.05). The mean lengths of postoperative hospitalization were 3.4, 5.4, and 5.8 days. Complications occurred in 24 SLC patients (2.3%), 2 LSC patients (9%), and 1 LSCA patient (3.7%). There was no mortality among the LSC and LSCA patients.
CONCLUSION
LSC and LSCA are safe and feasible alternatives for difficult cholecystectomies. These procedures help surgeons avoid bile duct injury and conversion to laparotomy. LSCA has the benefits of shorter operation time and less bleeding compared to LSC.

Keyword

Laparoscopic cholecystectomy; Morbidity; Bile ducts; Hemorrhage

MeSH Terms

Bile Ducts
Cholecystectomy*
Cholecystectomy, Laparoscopic
Gallbladder
Hemorrhage
Hospitalization
Humans
Laparotomy
Liver
Medical Records
Mortality
Retrospective Studies
Surgeons

Figure

• 

  Fig. 1 Transection planes in SLC (A), LSC (B), and LSCA (C). (A) In SLC, the cystic duct is exposed and transected. The dissection is then made between the gallbladder and the liver. (B) In LSC, the transection is made at the level of the neck or body of the GB. The dissection is then made between the GB and the liver. The GB stump is sutured or packed with fibrin sealant. (C) In LSCA, the transection is made at the level of the neck or body of the GB. Without GB dissection, the anterior wall of the GB is transected with electrocautery or ultrasonic scissors. The GB stump is then sutured or packed with fibrin sealant. SLC, standard laparoscopic cholecystectomy; GB, gallbladder; LSC, laparoscopic subtotal cholecystectomy; LSCA, laparoscopic subtotal cholecystectomy removing the anterior wall of the GB.

• 

  Fig. 2 Diagram of patients enrolled. GB, gallbladder; SLC, standard laparoscopic cholecystectomy; LSC, laparoscopic subtotal cholecystectomy; LSCA, laparoscopic subtotal cholecystectomy removing the anterior wall of the GB.

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