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Year : 2015  |  Volume : 34  |  Issue : 2  |  Page : 90-93

Subtotal cholecystectomy in difficult laparoscopic cholecystectomies: is it safe?

Department of General Surgery, Ain Shams University Hospitals, Cairo, Egypt

Correspondence Address:
Essam F Ebied
36 Iran Street, Dokkii, Cairo
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/1110-1121.155717

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Purpose Laparoscopic cholecystectomy is now accepted as the 'gold standard' procedure for cholecystectomy. However, this procedure can be dangerous in cases of unclear anatomy at the Callot's triangle. A significant proportion of patients with unclear anatomy are still converted to 'open' to complete the procedure. The other option is subtotal cholecystectomy rather than open conversion. Our purpose was to study the safety of laparoscopic subtotal cholecystectomy in cases where the clear identification of the anatomical land marks in Callot's triangle is difficult. Materials and methods Patients who underwent laparoscopic subtotal cholecystectomy between January 2011 and December 2011 were evaluated prospectively. These patients underwent subtotal cholecystectomy without isolation of the duct or artery, as this was judged to be hazardous, and the Hartmann pouch was transacted, stones were evacuated and the gall bladder remnant was closed by endoscopic sutures and a subhepatic drain left in situ. Results Laparoscopic subtotal cholecystectomy was performed in 30 elective procedures among 30 patients, male patients 18 (60%) and female patients 12 (40%). Their mean age was 52.6 years ± 12.65 SD. The mean operative time was 92 min ± 20 SD, and the mean hospital stay was 72.43 h ± 22 SD. We encountered one conversion into open and two patients who developed intra-abdominal collection. No mortalities were recorded. Conclusion Subtotal cholecystectomy is a safe procedure in cases where there is no clear identification of the structures in Callot's triangle. However, it is not a substitute for conversion into open, if deemed required.

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