Hamdy Abdallah, PhD. Faculty Of Medicine, Tanta University, Egypt
Background: When the critical view of safety can't be obtained during dissection of Calot’s triangle in difficult gallbladder, conversion to open surgery is recommended to prevent bile duct injury. Several “damage control” techniques, such as cholecystostomy and subtotal cholecystectomy (SC), aim to decrease the conversion rate and risks of bile duct injury.
Materials and methods: The medical records of all patients who had laparoscopic SC (LSC) for acute calcular cholecystitis (ACC) during the period from May 2009 to August 2016 at Tanta University Hospital, Egypt were retrospectively reviewed.
Results: During the study period, laparoscopic cholecystectomy (LC) was attempted in 68 difficult GBs out of 376 patients presenting with ACC. LSC was performed for 65 patients and cholecystostomy for the remaining 3 patients. LSC group included 50 females (77%) and 15 males (23%) with a mean age of 42.35±12.4 years. The mean duration of symptoms was 27.5±13.3 days before surgery. Six patients (9.2%) had pericholecystic abscesses and 4 (6.2%) had bile duct obstruction due to Mirrizi syndrome or choledocholithiasis (2 patients each). The cystic duct (CD) was dissected and controlled successfully in all patients and drains were used in 42 patients (64.6%). The mean operative blood loss was 45.28±18.6 CC and the mean operative time was 96.3±24.19 minutes. There were no conversions to open surgery, no operative complications or mortality. Three patients (4.6%) had superficial port site infection and 1 patient (1.5%) had post-ERCP bleeding that was controlled endoscopically. The mean postoperative hospital stay was 28±17.8 hours. No patients developed bile leak, intra-abdominal collections or jaundice and there was no postoperative mortality.
Conclusion: When surgery is indicated for difficult ACC, LSC with control of the CD, performed by experienced surgeons, is safe with excellent outcomes.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 84705
Program Number: P120
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster