Laparoscopic subtotal cholecystectomy: initial experience with laparoscopic management of difficult cholecystitis.
OBJECTIVE
Laparoscopic cholecystectomy (LC) is now accepted as the 'gold standard' procedure for cholecystectomy. However, a significant proportion of patients with complicated cholecystitis are still converted to 'open' to complete the procedure. Laparoscopic subtotal cholecystectomy (LSC) is an option, which is still too infrequently used.


METHODS
A single surgeon in our NHS trust has performed 1150 LCs since September 1999. The procedure was converted to LSC in 52 cases (4.52%) due to complicated cholecystitis. The data were collected and prospectively analysed for any morbidity or complications in the peri-operative period.


RESULTS
At the initial presentation, 21 patients (40.38%) were diagnosed with recurrent biliary colic, 24 patients (46.15%) had acute cholecystitis, 6 patients (11.53%) had jaundice, and 1 patient (1.92%) had peritonitis due to gallbladder (GB) perforation. Twenty-six cases (50%) were performed as emergencies, i.e. within one week of symptoms, and 26 (50%) were planned for surgery within four weeks after symptoms started. The cystic duct or Hartmann's pouch stump was closed using endo-loop application in 34 (65.38%), intracorporeal suturing of stump of Hartmann's pouch in 13 (25%), and closure of cystic duct opening in the Hartmann's pouch by purse-string suturing in 5 cases (9.62%).


CONCLUSIONS
LSC is a safe option in treating gallstone disease when inflammation or fibrosis precludes conventional dissection of Calot's triangle. LSC can clearly help reduce morbidity associated with open laparotomy.
Department of General Surgery, Princess Royal University Hospital Farnborough, London. tasneemtarun@hotmail.com
T
T
Singhal
S
S
Balakrishnan
A
A
Hussain
J
J
Nicholls
S
S
Grandy-Smith
S
S
El-Hasani
D017081:Cholecystectomy, Laparoscopic / Q000379:methods* / Q000592:standards; D002764:Cholecystitis / Q000601:surgery*; D006801:Humans; D011183:Postoperative Complications / Q000517:prevention & control; D011446:Prospective Studies; D012008:Recurrence; D016896:Treatment Outcome