Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions.
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.


CONCLUSIONS
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.
Horiuchi
Atsushi
A
Department of Surgery 2, Ehime University School of Medicine, Shitsukawa, Toon City, Ehime, 791-0295, Japan. atsushi@m.ehime-u.ac.jp
Watanabe
Yuji
Y
Doi
Takashi
T
Sato
Kouichi
K
Yukumi
Shungo
S
Yoshida
Motohira
M
Yamamoto
Yuji
Y
Sugishita
Hiroki
H
Kawachi
Kanji
K
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000706:statistics & numerical data; D002764:Cholecystitis / Q000150:complications / Q000473:pathology / Q000601:surgery*; D003549:Cystic Duct / Q000601:surgery; D004210:Dissection; D005260:Female; D005355:Fibrosis; D006801:Humans; D007813:Laparotomy / Q000706:statistics & numerical data; D008026:Ligation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013536:Suture Techniques; D013997:Time Factors; D000267:Tissue Adhesions / Q000209:etiology