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.
Singhal
T
T
Department of General Surgery, Princess Royal University Hospital Farnborough, London. tasneemtarun@hotmail.com
Balakrishnan
S
S
Hussain
A
A
Nicholls
J
J
Grandy-Smith
S
S
El-Hasani
S
S
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