Hamdy S Abd Alla, PhD. Faculty of Medicine, Tanta University Hospital, 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 or other “damage control” alternatives as cholecystostomy and subtotal cholecystectomy are recommended to prevent bile duct injury
Materials and methods: The medical records of all patients presented with acute calculous cholecystitis at our institution during the period from June 2008 to August 2016 were retrospectively reviewed and analyzed.
Results: Laparoscopic cholecystectomy was attempted in 71 difficult gallbladders out of 379 patients presenting with acute calculous cholecystitis. In 6 patients (8.5%), conversion to open surgery or laparoscopic cholecystostomy was performed. Laparoscopic subtotal cholecystectomy with dissection and control of the cystic duct was performed for the remaining 65 patients (91.5%) including 50 females (77%) and 15 males (23%) with a mean age of 42.35±12.4 years. 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 operative complications or mortality. The mean hospital stay was 28±17.8 hours. There was no postoperative jaundice, bile leak, intra-abdominal collections or mortality.
Conclusion: When surgery is indicated for difficult acute calculous cholecystitis, laparoscopic subtotal cholecystectomy with control of the cystic duct is safe with excellent outcomes. However, if the critical view of safety can’t be achieved due to obscured anatomy at Calot’s triangle, conversion to open surgery or cholecystostomy must be performed to prevent bile duct injury.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88025
Program Number: P541
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster