Delayed Laparoscopic Subtotal Cholecystectomy in Acute Cholecystitis with Severe Fibrotic Adhesions

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2008 Apr 5

PMID 18389315

Citations 20

Authors

Atsushi Horiuchi

Yuji Watanabe

Takashi Doi

Kouichi Sato

Shungo Yukumi

Motohira Yoshida

Yuji Yamamoto

Hiroki Sugishita

Kanji Kawachi

Affiliations

Soon will be listed here.

Abstract

Background: Conversion rate to open surgery is higher for patients with acute cholecystitis than in those without acute cholecystitis. We attempted to develop a laparoscopic subtotal cholecystectomy to decrease this conversion rate.

Methods: From 2000 to 2005, laparoscopic cholecystectomy for acute cholecystitis was performed in 60 patients (22 women, 38 men). Patients were divided into two groups: group A (2000 to 2002, n = 22) and group B (2003 to 2005, n = 38). When significant difficulty was encountered dissecting the gallbladder from its bed, we incised the gallbladder wall leaving the posterior wall and cauterizing the remnant mucosa (subtotal cholecystectomy, SC-1). When dissection of the gall bladder neck and triangle of Calot was difficult, the neck of the gallbladder was sutured despite clipping (SC-2).

Results: Mean duration from onset of symptoms to operation was 55.3 +/- 52.0 days. SC-1 was performed in 8 patients in group A and 18 patients in group B. SC-2 was performed in three patients in Group B. Conversion rate was 18.1% (4/22) in group A and 0% (0/38) in group B, compared to 0.4% (1/221) for patients without acute cholecystitis. No complications were associated with ablated gallbladder mucosa.

Conclusion: Laparoscopic subtotal cholecystectomy offers safe and effective treatment for acute cholecystitis. The conversion rate in group B is decreased by avoiding hazardous dissection of the cystic duct.

Citing Articles

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Intraoperative imaging and management of common duct stones during subtotal cholecystectomy.

Johnston T, Cotter R, Soybel D, Santos B Surg Endosc. 2024; 38(10):6083-6089.

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Review of the Literature on Partial Resections of the Gallbladder, 1898-2022: The Outline of the Conception of Subtotal Cholecystectomy and a Suggestion to Use the Terms 'Subtotal Open-Tract Cholecystectomy' and 'Subtotal Closed-Tract....

Lunevicius R J Clin Med. 2023; 12(3).

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Laparoscopic subtotal cholecystectomy after percutaneous transhepatic gallbladder drainage for grade II or III acute cholecystitis.

Ie M, Katsura M, Kanda Y, Kato T, Sunagawa K, Mototake H BMC Surg. 2021; 21(1):386.

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Subtotal cholecystectomy for difficult acute cholecystitis: how to finalize safely by laparoscopy-a systematic review.

Toro A, Teodoro M, Khan M, Schembari E, Di Saverio S, Catena F World J Emerg Surg. 2021; 16(1):45.

PMID: 34496916 PMC: 8424983. DOI: 10.1186/s13017-021-00392-x.

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