Subtotal Cholecystectomy Versus Total Cholecystectomy for Technically Difficult Cholecystitis

V.v. Grubnik, Prof, V.v. Ilyashenko, PhD, M.v. Prikupenko, V.v. Grubnik. Odessa national medical university

Introduction. In severe cholecystitis laparoscopic cholecystectomy (LC) can be technically difficult with a high risk of duct and arterial injury. To prevent injury, conversion to open cholecystectomy (OC) is usually made. Another solution is performing of laparoscopic subtotal cholecystectomy (LSTC).

Aim of the study was to investigate the safety and complications of laparoscopic subtotal cholecystectomy (LSTC) compared to conversion to OC for technically difficult cholecystitis.

Methods an? procedures. A retrospective review of 5708 LC performed from 2005 to 2013 in single center was done. In the 1st period, from 2005 to 2008, 2720 LC were performed. In technical difficulties conversion to OC was done. In the 2nd period, from 2009 to 2013, 2988 LC were performed. In technical difficulties LSTC was done.

Results. During the 1st period, there were 127 patients (4,7 %) with technically difficult LC whom conversion to OC was done. Complication rate among these patients was 23 %, bile duct injuries were detected in 3 patients (2,4 %), mortality was 1,6 %.

During the 2nd period, there were 84 patients with technically difficult LC, thus LSTC was performed for 69 patients of them. Therefore, conversion to OC was made for the remaining 15 patients (0,5 %). There were no bile duct injuries and no mortality in these patients. Complication rate after LSTC was 8,7 %. Quality of life was assessed 6 – 48 months after surgery in 102 patients whom conversion to OC was done, and in 58 patients whom LSTC was done. Quality of life was better in patients after LSTC.

Conclusions. LSTC is good alternative to conversion to OC in complicated cases. It is good solution to prevent bile duct injury and save a principle of minimally invasive procedure in technically difficult LC, especially in high risk patients.

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