Laparoscopic Subtotal Cholecystectomy for Severe Cholecystitis

Overview

Journal Surg Endosc

Publisher Springer

Specialties Gastroenterology
General Surgery
Radiology

Date 2015 Jun 21

PMID 26091984

Citations 10

Authors

Yuji Shingu

Shunichiro Komatsu

Shinji Norimizu

Yoshiro Taguchi

Eiji Sakamoto

Affiliations

Soon will be listed here.

Abstract

Background: The concept of laparoscopic subtotal cholecystectomy (LSC), without approaching Calot's triangle to avoid both laparotomy and serious complications, is not widely accepted. In this study, we evaluated the outcomes of LSC for severe cholecystitis when dissection of the cystic duct and cystic artery is hazardous.

Methods: From January 2004 to December 2013, 110 consecutive patients who underwent LSC without ligation of the cystic duct and vessels were enrolled in this retrospective study. Their clinical records, including operative records and outcomes, had been entered into a prospectively maintained database and were analyzed.

Results: The mean operating time and blood loss were 121 min and 33.8 ml, respectively. All LSCs were completed without conversion to an open procedure. No injuries to the bile duct or vessels were experienced. Postoperative complications occurred in ten (9.1%) patients, including subhepatic hematoma in 3, bile leakage in 3, and subhepatic abscess in 1. Patients recovered from complications without requiring re-operation. During follow-up periods (mean 30.7 months), symptomatic biliary stone diseases relapsed in three patients (2.7%) and were successfully treated by endoscopic management.

Conclusions: LSC without an attempt to dissect Calot's triangle is a safe and feasible procedure that can avoid conversion to laparotomy.

Citing Articles

Bailout for the Difficult Gallbladder: Subtotal vs. Open Cholecystectomy-A Retrospective Tertiary Care Center Experience.

Aloraini A, Alburakan A, Alhelal F, Alabdi G, Elmutawi H, Alzahrani N Medicina (Kaunas). 2024; 60(10).

PMID: 39459429 PMC: 11509598. DOI: 10.3390/medicina60101642.

Impact of fundus-first laparoscopic cholecystectomy for severe cholecystitis.

Osawa T, Fukami Y, Komatsu S, Saito T, Matsumura T, Kurahashi S Surg Endosc. 2023; 37(8):6129-6134.

PMID: 37140718 DOI: 10.1007/s00464-023-10080-3.

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).

PMID: 36769878 PMC: 9917859. DOI: 10.3390/jcm12031230.

Laparoscopic subtotal cholecystectomy: comparison of reconstituting and fenestrating techniques.

Koo J, Chan Y, Shelat V Surg Endosc. 2020; 35(3):1014-1024.

PMID: 33128079 DOI: 10.1007/s00464-020-08096-0.

Safe cholecystectomy multi-society practice guideline and state-of-the-art consensus conference on prevention of bile duct injury during cholecystectomy.

Brunt L, Deziel D, Telem D, Strasberg S, Aggarwal R, Asbun H Surg Endosc. 2020; 34(7):2827-2855.

PMID: 32399938 DOI: 10.1007/s00464-020-07568-7.

References

Lawes D, Motson R . Anatomical orientation and cross-checking--the key to safer laparoscopic cholecystectomy (Br J Surg 2005; 92: 663-664). Br J Surg. 2005; 92(11):1454-5. DOI: 10.1002/bjs.5223. View

Nebiker C, Baierlein S, Beck S, von Flue M, Ackermann C, Peterli R . Is routine MR cholangiopancreatography (MRCP) justified prior to cholecystectomy?. Langenbecks Arch Surg. 2008; 394(6):1005-10. DOI: 10.1007/s00423-008-0447-7. View

Dalton S, Balupuri S, Guest J . Routine magnetic resonance cholangiopancreatography and intra-operative cholangiogram in the evaluation of common bile duct stones. Ann R Coll Surg Engl. 2005; 87(6):469-70. PMC: 1964119. DOI: 10.1308/003588405X51137. View

Phillips M, Joseph M, Dellon E, Grimm I, Farrell T, Rupp C . Surgical and endoscopic management of remnant cystic duct lithiasis after cholecystectomy--a case series. J Gastrointest Surg. 2014; 18(7):1278-83. DOI: 10.1007/s11605-014-2530-4. View

Horiuchi A, Watanabe Y, Doi T, Sato K, Yukumi S, Yoshida M . Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions. Surg Endosc. 2008; 22(12):2720-3. DOI: 10.1007/s00464-008-9879-y. View

Gutt C, Encke J, Koninger J, Harnoss J, Weigand K, Kipfmuller K . Acute cholecystitis: early versus delayed cholecystectomy, a multicenter randomized trial (ACDC study, NCT00447304). Ann Surg. 2013; 258(3):385-93. DOI: 10.1097/SLA.0b013e3182a1599b. View

Michalowski K, Bornman P, Krige J, Gallagher P, Terblanche J . Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg. 1998; 85(7):904-6. DOI: 10.1046/j.1365-2168.1998.00749.x. View

Siddiqui A, Mitroo P, Kowalski T, Loren D . Endoscopic sphincterotomy with or without cholecystectomy for choledocholithiasis in high-risk surgical patients: a decision analysis. Aliment Pharmacol Ther. 2006; 24(7):1059-66. DOI: 10.1111/j.1365-2036.2006.03103.x. View

Sinha I, Smith M, Safranek P, Dehn T, Booth M . Laparoscopic subtotal cholecystectomy without cystic duct ligation. Br J Surg. 2007; 94(12):1527-9. DOI: 10.1002/bjs.5889. View

10.

Cottier D, Mckay C, ANDERSON J . Subtotal cholecystectomy. Br J Surg. 1991; 78(11):1326-8. DOI: 10.1002/bjs.1800781119. View

11.

Zhu J, Zhang Z . Laparoscopic remnant cholecystectomy and transcystic common bile duct exploration for gallbladder/cystic duct remnant with stones and choledocholithiasis after cholecystectomy. J Laparoendosc Adv Surg Tech A. 2014; 25(1):7-11. DOI: 10.1089/lap.2014.0186. View

12.

Ransom K . Laparoscopic management of acute cholecystitis with subtotal cholecystectomy. Am Surg. 1998; 64(10):955-7. View

13.

Davidoff A, Pappas T, Murray E, Hilleren D, Johnson R, Baker M . Mechanisms of major biliary injury during laparoscopic cholecystectomy. Ann Surg. 1992; 215(3):196-202. PMC: 1242421. DOI: 10.1097/00000658-199203000-00002. View

14.

Henneman D, da Costa D, Vrouenraets B, van Wagensveld B, Lagarde S . Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc. 2012; 27(2):351-8. DOI: 10.1007/s00464-012-2458-2. View

15.

Darabos N, Stare R . Gallbladder cancer: laparoscopic and classic cholecystectomy. Surg Endosc. 2003; 18(1):144-7. DOI: 10.1007/s00464-002-9269-9. View

16.

Kuwabara J, Watanabe Y, Kameoka K, Horiuchi A, Sato K, Yukumi S . Usefulness of laparoscopic subtotal cholecystectomy with operative cholangiography for severe cholecystitis. Surg Today. 2013; 44(3):462-5. PMC: 3923106. DOI: 10.1007/s00595-013-0626-1. View

17.

Singhal T, Balakrishnan S, Hussain A, Nicholls J, Grandy-Smith S, El-Hasani S . Laparoscopic subtotal cholecystectomy: initial experience with laparoscopic management of difficult cholecystitis. Surgeon. 2009; 7(5):263-8. DOI: 10.1016/s1479-666x(09)80002-4. View

18.

Rattner D, Ferguson C, Warshaw A . Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg. 1993; 217(3):233-6. PMC: 1242774. DOI: 10.1097/00000658-199303000-00003. View

19.

Palanivelu C, Rangarajan M, Jategaonkar P, Madankumar M, Anand N . Laparoscopic management of remnant cystic duct calculi: a retrospective study. Ann R Coll Surg Engl. 2008; 91(1):25-9. PMC: 2752238. DOI: 10.1308/003588409X358980. View

20.

Zehetner J, Leidl S, Wuttke M, Wayand W, Shamiyeh A . Conversion in laparoscopic cholecystectomy in low versus high-volume hospitals: is there a difference?. Surg Laparosc Endosc Percutan Tech. 2010; 20(3):173-6. DOI: 10.1097/SLE.0b013e3181df9dac. View