title: Usefulness of laparoscopic subtotal cholecystectomy with operative cholangiography for severe cholecystitis.
abstract: OBJECTIVE
  Cholecystectomy can become hazardous when inflammation develops, leading to anatomical changes in Calot's triangle. We attempted to study the safety and efficacy of laparoscopic subtotal cholecystectomy (LSC) to decrease the incidence of complications and the rate of conversion to open surgery.
  
  
  METHODS
  Patients who underwent LSC between January 2005 and December 2008 were evaluated retrospectively. The operations were performed laparoscopically irrespective of the grade of inflammation estimated preoperatively. However, patients with severe inflammation of the gallbladder underwent LSC involving resection of the anterior wall of the gallbladder, removal of all stones and placement of an infrahepatic drainage tube. To prevent intraoperative complications, including bile duct injury, intraoperative cholangiography was performed.
  
  
  RESULTS
  LSC was performed in 26 elective procedures among 26 patients (eight females, 18 males). The median patient age was 69 years (range 43-82 years). The median operative time was 125 min (range 60-215 min) and the median postoperative inpatient stay was 6 days (range 3-21 days). Cholangiography was performed during surgery in 24 patients. One patient underwent postoperative endoscopic sphincterotomy for a retained common bile duct stone that was found on cholangiography during surgery. Neither complications nor conversion to open surgery were encountered in this study.
  
  
  CONCLUSIONS
  LSC with the aid of intraoperative cholangiography is a safe and effective treatment for severe cholecystitis.
authors.affiliation: Second Department of Surgery, Ehime University School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan, kuwa-la-pa-jun@hotmail.co.jp.
authors.forename: Jun
authors.initials: J
authors.lastname: Kuwabara
authors.forename: Yuji
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kameoka
authors.forename: Atsushi
authors.initials: A
authors.lastname: Horiuchi
authors.forename: Kouichi
authors.initials: K
authors.lastname: Sato
authors.forename: Shungo
authors.initials: S
authors.lastname: Yukumi
authors.forename: Motohira
authors.initials: M
authors.lastname: Yoshida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Hiroki
authors.initials: H
authors.lastname: Sugishita
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002758:Cholangiography; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D007432:Intraoperative Period; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000517:prevention & control; D012189:Retrospective Studies; D012449:Safety; D012720:Severity of Illness Index; D025321:Surgery, Computer-Assisted / Q000379:methods*; D016896:Treatment Outcome