title: Laparoscopic subtotal cholecystectomy for severe cholecystitis.
abstract: BACKGROUND
  The concept of laparoscopic subtotal cholecystectomy (LSC), without approaching Calot's triangle to avoid both laparotomy and serious complications, is not widely accepted. In this study, we evaluated the outcomes of LSC for severe cholecystitis when dissection of the cystic duct and cystic artery is hazardous.
  
  
  METHODS
  From January 2004 to December 2013, 110 consecutive patients who underwent LSC without ligation of the cystic duct and vessels were enrolled in this retrospective study. Their clinical records, including operative records and outcomes, had been entered into a prospectively maintained database and were analyzed.
  
  
  RESULTS
  The mean operating time and blood loss were 121 min and 33.8 ml, respectively. All LSCs were completed without conversion to an open procedure. No injuries to the bile duct or vessels were experienced. Postoperative complications occurred in ten (9.1%) patients, including subhepatic hematoma in 3, bile leakage in 3, and subhepatic abscess in 1. Patients recovered from complications without requiring re-operation. During follow-up periods (mean 30.7 months), symptomatic biliary stone diseases relapsed in three patients (2.7%) and were successfully treated by endoscopic management.
  
  
  CONCLUSIONS
  LSC without an attempt to dissect Calot's triangle is a safe and feasible procedure that can avoid conversion to laparotomy.
authors.affiliation: Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan. shingu@nagoya2.jrc.or.jp.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shingu
authors.affiliation: Department of Gastroenterological Surgery, Aichi Medical University, Nagakute, Aichi, Japan.
authors.forename: Shunichiro
authors.initials: S
authors.lastname: Komatsu
authors.affiliation: Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Shinji
authors.initials: S
authors.lastname: Norimizu
authors.affiliation: Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Yoshiro
authors.initials: Y
authors.lastname: Taguchi
authors.affiliation: Department of Digestive Surgery, Nagoya Daini Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
authors.forename: Eiji
authors.initials: E
authors.lastname: Sakamoto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D002764:Cholecystitis / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: Calot’s triangle; Cholecystitis; Laparoscopic subtotal cholecystectomy