Sunay Bhat1, Gokul Kruba Shanker1, Vadiraj Hunnur1, N.Subrahmaneswara Babu2, Balu Kuppusamy3. 1Dept.of Surgical Gastroenterology,VGM Gastro Care,Coimbatore, 2Dept. of Surgical Gastroenterology,JIPMER, Pondicherry., 3Dept. of Surgical Gastroenterology,GEM Hospital,Coimbatore
INTRODUCTION: Laparoscopic subtotal cholecystectomy is widely accepted as a safe alternative to the conventional laparoscopic cholecystectomy in case of acute cholecystitis with frozen calot’s triangle. The remnant stump of the gallbladder may be either sutured or looped. However, there are limited studies comparing the outcomes of the two techniques. The present study is aimed at comparing loop and suture closure of the gall bladder stump.
METHODS: A retrospective analysis of our prospectively maintained database revealed that between January 2013 and December 2016. 81 patients underwent laparoscopic subtotal cholecystectomy for acute cholecystitis, chronic cholecystitis or empyema gallbladder with frozen calot’s triangle. The decision to use endoloop or sutures for stump closure was made intra-operatively after dividing the gallbladder through the infundibulum. A no.20 sized drain was kept in all the cases. The patients were discharged with drain in situ, and were reviewed on post-operative day 7 during which an ultrasound was done and drain removed if the progress was satisfactory. The intra-operative and post-operative data between the two groups were recorded and analyzed.
RESULTS: Endoloop closure was performed in 45 patients and suture closure using 2.0 ethibond was done in 36 patients. Three patients from the sutured group had post operative bile leak among which one patient underwent endobiliary stenting. The other 2 were managed conservatively while the drain had to be retained for 2 weeks. Two patients in the endoloop group were detected to have retained stone in the remnant gallbladder cuff among which one had recurrent cholecystitis requiring laparoscopic completion cholecystectomy. None of the patients had bile duct injury or surgical site infection. Mean post operative stay was 2.5+1.2 days, did not significantly vary between the groups. Suturing needed more surgical expertise and had prolonged operative time than endoloop (68+22min versus 84+18min, p=0.04).
CONCLUSION: Suture or loop closure of the remnant gallbladder after subtotal cholecystectomy are equally effective. Suturing the stump may be associated with increased incidence of biliary leak while endoloop may have higher incidence of retained gallstones. The choice between the two may be made intra-operatively based on the surgeon’s expertise and preference.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87358
Program Number: P112
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster