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Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis

Received: 29 September 2017     Accepted: 10 October 2017     Published: 12 November 2017
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Abstract

Background: When the critical view of safety (CVS) 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 (ACC) during the study period were retrospectively reviewed and analyzed. Results: Laparoscopic cholecystectomy (LC) was attempted in 71 difficult gallbladders out of 379 patients presenting with ACC. In 6 patients (8.5%), conversion to open surgery or laparoscopic cholecystostomy was performed. Laparoscopic subtotal cholecystectomy (LSC) 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 ACC, LSC with control of the cystic duct is safe with excellent outcomes. However, if the CVS 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.

Published in Journal of Surgery (Volume 5, Issue 6)
DOI 10.11648/j.js.20170506.15
Page(s) 111-117
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Subtotal Cholecystectomy, Laparoscopy, Acute Calculous Cholecystitis

References
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[2] Buddingh KT, Hofker HS, ten Cate Hoedemaker HO, et al (2011) Safety measures during cholecystectomy: results of a nationwide survey. World J Surg 35:1235–1241.
[3] Bender JS, Zenilman ME (1995) Immediate laparoscopic cholecystectomy as definitive therapy for acute cholecystitis. Surg Endosc 9: 1081–1084.
[4] Garber SM, Korman J, Cosgrove JM, Cohen JR (1997) Early laparoscopic cholecystectomy for acute cholecystitis. Surg Endosc 11: 347– 350.
[5] Koo KP, Thirlby RC (1996) Laparoscopic cholecystectomy in acute cholecystitis: what is the optimal time for operation? Arch Surg 131: 540–545
[6] Lo CM, Liu CL, Lai ECS, Fan ST, Wong J (1996) Early versus delayed laparoscopic cholecystectomy for treatment of acute cholecystitis. Ann Surg 223: 37–42.
[7] McArthur P, Cuschieri A, Sells A, Shields R (1975) Controlled clinical trial comparing early with interval cholecystectomy for acute cholecystitis. Br J Surg 62: 850–852.
[8] Wolf AS, Nijsse BA, Sokal SM, et al (2009) Surgical outcomes of open cholecystectomy in the laparoscopic era. Am J Surg 197:781–784.
[9] Lee J, Miller P, Kermani R, Dao H, O’ Donnell K (2012) Gallbladder damage control: compromised procedure for compromised patients. Surg Endosc 26(10):2779-2783.
[10] Eikermann M, Siegel R, Broeders I, et al (2012) Prevention and treatment of bile duct injuries during laparoscopic cholecystectomy: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES). Surg Endosc 26 (11):3003-3039.
[11] Booij KA, de Reuver PR, van Delden OM, Gouma DJ (2009) Conversion has to be learned: bile duct injury following conversion to open cholecystectomy. Ned Tijdschr Geneeskd 153:A296.
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[13] Hirota M, Takada T, Kawarada Y, et al (2007) Diagnostic criteria and severity assessment of acute cholecystitis: Tokyo Guidelines J Hepatobiliary Pancreat Surg 14:78–8.
[14] Tzovaras G, Zacharoulis D, Liakou P, et al (2006) Timing of laparoscopic cholecystectomy for acute cholecystitis: a prospective nonrandomized study. World J Gastroenterol 12:5528–5531.
[15] Mercer SJ, Knight JS, Toh SK, et al (2004) Implementation of a specialist-led service for the management of acute gallstone disease. Br J Surg 91:504–508.
[16] Rattner DW, Ferguson C, Warshaw AL (1993) Factors associated with successful laparoscopic cholecystectomy for acute cholecystitis. Ann Surg 217: 233–6.
[17] Schafer M, Krahenbuhl L, Buchler MW (2001) Predictive factors for the type of surgery in acute cholecystitis. Am J Surg 182: 291-7.
[18] Livingston EH, Rege R (2004) A nationwide study of conversion from laparoscopic to open cholecystectomy. Am J Surg 188: 205–11.
[19] Elshaer M, Gravante G, Thomas K, et al (2015) Subtotal Cholecystectomy for “Difficult Gallbladders” Systematic Review and Meta-analysis JAMA Surg 150 (2):159-168.
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  • APA Style

    Hamdy Sedky Abdallah. (2017). Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis. Journal of Surgery, 5(6), 111-117. https://doi.org/10.11648/j.js.20170506.15

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    ACS Style

    Hamdy Sedky Abdallah. Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis. J. Surg. 2017, 5(6), 111-117. doi: 10.11648/j.js.20170506.15

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    AMA Style

    Hamdy Sedky Abdallah. Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis. J Surg. 2017;5(6):111-117. doi: 10.11648/j.js.20170506.15

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  • @article{10.11648/j.js.20170506.15,
      author = {Hamdy Sedky Abdallah},
      title = {Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis},
      journal = {Journal of Surgery},
      volume = {5},
      number = {6},
      pages = {111-117},
      doi = {10.11648/j.js.20170506.15},
      url = {https://doi.org/10.11648/j.js.20170506.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20170506.15},
      abstract = {Background: When the critical view of safety (CVS) 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 (ACC) during the study period were retrospectively reviewed and analyzed. Results: Laparoscopic cholecystectomy (LC) was attempted in 71 difficult gallbladders out of 379 patients presenting with ACC. In 6 patients (8.5%), conversion to open surgery or laparoscopic cholecystostomy was performed. Laparoscopic subtotal cholecystectomy (LSC) 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 ACC, LSC with control of the cystic duct is safe with excellent outcomes. However, if the CVS 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.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis
    AU  - Hamdy Sedky Abdallah
    Y1  - 2017/11/12
    PY  - 2017
    N1  - https://doi.org/10.11648/j.js.20170506.15
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    JO  - Journal of Surgery
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    EP  - 117
    PB  - Science Publishing Group
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    UR  - https://doi.org/10.11648/j.js.20170506.15
    AB  - Background: When the critical view of safety (CVS) 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 (ACC) during the study period were retrospectively reviewed and analyzed. Results: Laparoscopic cholecystectomy (LC) was attempted in 71 difficult gallbladders out of 379 patients presenting with ACC. In 6 patients (8.5%), conversion to open surgery or laparoscopic cholecystostomy was performed. Laparoscopic subtotal cholecystectomy (LSC) 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 ACC, LSC with control of the cystic duct is safe with excellent outcomes. However, if the CVS 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.
    VL  - 5
    IS  - 6
    ER  - 

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Author Information
  • General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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