title: Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis.
abstract: OBJECTIVE
  For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility.
  
  
  METHODS
  In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed.
  
  
  RESULTS
  There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p<0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren't any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p<0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p<0.001).
  
  
  CONCLUSIONS
  LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery.
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: In Oh
authors.initials: IO
authors.lastname: Jeong
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Jang Yong
authors.initials: JY
authors.lastname: Kim
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Yun-Mee
authors.initials: YM
authors.lastname: Choe
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Sun Keun
authors.initials: SK
authors.lastname: Choi
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Yoon Seok
authors.initials: YS
authors.lastname: Heo
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Keon-Young
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Sei Joong
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Young Up
authors.initials: YU
authors.lastname: Cho
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Seung-Ik
authors.initials: SI
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Kee Chun
authors.initials: KC
authors.lastname: Hong
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Kyung Rae
authors.initials: KR
authors.lastname: Kim
authors.affiliation: Department of Surgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Seok-Hwan
authors.initials: SH
authors.lastname: Shin
keywords: Acute cholecystitis; Laparoscopic subtotal cholecystectomy