THE STUDY OF LAPAROSCOPIC SUBTOTAL CHOLECYSTECTOMY FOR DIFFICULT GALLBLADDERS IN CHRONIC CHOLECYSTITIS

Abstract

Background: Laparoscopic subtotal cholecystectomy (LSTC) is a bailout procedure that is undertaken when it is not safe to proceed with a laparoscopic total cholecystectomy owing to dense adhesions in Calot’s triangle. Aim and Objective: To find out whether our technique of laparoscopic modified subtotal cholecystectomy (LMSC) is suitable with an acceptable morbidity and outcome. Material and Methods: A retrospective analysis of prospectively collected data on 60 consecutive patients who underwent cholecystectomy was done at a different hospital in Bhuvneswar and  Puri, Odisa, India. The study included both elective and emergency cholecystectomies in adult patients. The data is as follows: Patient's demographics, operative details, including intra- and postoperative complications, and postoperative stay, including follow-up, were recorded and analyzed. Result: Of the 60 patients undergoing LMSC, 26 (43.33%) were males and 34 (57.67%) were females [mean age 51 (20–70) years]. Fifty-two (86.67%) patients were elective, and eight (13.33%) underwent emergency operations [Table 1]. None from this group needed conversion to an open procedure.The patients who underwent LMSC often had multiple pathological findings that prompted the procedure: 50 (83.33%) had dense adhesions, 20 (33.33%) had acute inflammation, 21 (35%) had severely contracted GB, 13 (21.67%) had empyema of the GB, 6 (10%) had Mirizzi's syndrome, and 3 (5%) had gangrenous GB. The mean operating time for LMSC was 124 (50–140) minutes. Conclusion: Our technique of LMSC avoided conversion in 6.7% of patients, and we believe that it is feasible and safe for difficult GBs with a positive outcome.