Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지
DOI QR코드

DOI QR Code

Laparoscopic subtotal cholecystectomy in difficult gallbladder: Our experience in a tertiary care center

  • Kulbhushan Haldeniya (Department of Surgical Gastroenterology and HPB Unit, National Institute of Medical Sciences and Research, NIMS University) ;
  • Krishna S. R. (Department of Surgical Gastroenterology and HPB Unit, National Institute of Medical Sciences and Research, NIMS University) ;
  • Annagiri Raghavendra (Department of Surgical Gastroenterology and HPB Unit, National Institute of Medical Sciences and Research, NIMS University) ;
  • Pawan Kumar Singh (Department of Surgical Gastroenterology and HPB Unit, National Institute of Medical Sciences and Research, NIMS University)
  • Received : 2023.12.08
  • Accepted : 2024.01.30
  • Published : 2024.05.31
Download PDF
⟨ Previous Next ⟩

Abstract

Backgrounds/Aims: Open cholecystectomy is becoming obsolete and laparoscopic cholecystectomy has become the treatment of choice in gallstone diseases. Difficult gallbladders are encountered whenever there is a frozen calot's triangle, obliterated cystic plate, or both. Rather than converting to open procedure, there has been a growing preference for laparoscopic subtotal cholecystectomy (LSC) during difficult gallbladders. This study aimed to assess the advantages, indications, and viability of LSC in difficult gallbladders. Methods: The study included patients undergoing laparoscopic cholecystectomy in NIMS Hospital, Jaipur, from January 2021 to January 2023. Data of the patients who underwent LSC for difficult gallbladders included demographics, comorbidities, operative time, conversion to open cholecystectomy, length of hospital stay, and complications. LSC was classified into three types depending on the part of the gallbladder remnant. Results: A total of 728 patients underwent laparoscopic cholecystectomy. Among them, 41 patients (5.6%) were attempted for LSC. However, one patient was converted to an open procedure and the rest 40 underwent LSC. LSC was divided into 3 types, 4 patients underwent LSC type I, 34 patients underwent type II, and 2 patients type III. The average operating time and postoperative length of hospital stay were 86.2 minutes and 2.1 days, respectively. Two patients had surgical site infection. No patient had a bile leak and none required intensive care unit care. Conclusions: LSC is a safe and feasible option for use in difficult gallbladders.

Keywords

References

  1. Unisa S, Jagannath P, Dhir V, Khandelwal C, Sarangi L, Roy TK. Population-based study to estimate the prevalence and determine risk factors of gallbladder diseases in the rural Gangetic basin of North India. HPB (Oxford) 2011;13:117-125. https://doi.org/10.1111/j.1477-2574.2010.00255.x
  2. Gallstones and laparoscopic cholecystectomy. NIH Consens Statement 1992;10:1-28.
  3. Elshaer M, Gravante G, Thomas K, Sorge R, Al-Hamali S, Ebdewi H. Subtotal cholecystectomy for "difficult gallbladders": systematic review and meta-analysis. JAMA Surg 2015;150:159-168. https://doi.org/10.1001/jamasurg.2014.1219
  4. SalkyBA, Edye MB. The difficult cholecystectomy: problems related to concomitant diseases. Semin Laparosc Surg 1998;5:107-114.
  5. Laws HL. The difficult cholecystectomy: problems during dissection and extraction. Semin Laparosc Surg 1998;5:81-91. https://doi.org/10.1177/155335069800500203
  6. Gode D, Palanivelu C, Syed ZQ. New variants of laparoscopic subtotal cholecystectomy in management of acute cholecystitis. Int J Med Sci Public Health 2014;3:397-400. https://doi.org/10.5455/ijmsph.2014.300120141
  7. Henneman D, da Costa DW, Vrouenraets BC, van Wagensveld BA, Lagarde SM. Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc 2013;27:351-358. https://doi.org/10.1007/s00464-012-2458-2
  8. Deziel DJ, Millikan KW, Economou SG, Doolas A, Ko ST, Airan MC. Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases. Am J Surg 1993;165:9-14. https://doi.org/10.1016/S0002-9610(05)80397-6
  9. Strasberg SM. Error traps and vascular-biliary injury in laparoscopic and open cholecystectomy. J Hepatobiliary Pancreat Surg 2008;15:284-292. https://doi.org/10.1007/s00534-007-1267-9
  10. Tornqvist B, Waage A, Zheng Z, Ye W, Nilsson M. Severity of acute cholecystitis and risk of iatrogenic bile duct injury during cholecystectomy, a population-based case-control study. World J Surg 2016;40:1060-1067. https://doi.org/10.1007/s00268-015-3365-1
  11. Henneman D, da Costa DW, Vrouenraets BC, van Wagensveld BA, Lagarde SM. Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc 2013;27:351-358. https://doi.org/10.1007/s00464-012-2458-2
  12. Boyd K, Bradley NA, Cannings E, Shearer C, Wadhawan H, Wilson MSJ, et al. Laparoscopic subtotal cholecystectomy; change in practice over a 10-year period. HPB (Oxford) 2022;24:759-763. https://doi.org/10.1016/j.hpb.2021.10.003