Laparoscopic subtotal cholecystectomy for the difficult gallbladder.

Abstract

Abstract Background: Successful cholecystectomy hinges on accurate identification and secure closure of the cystic duct, a process made significantly more difficult when inflammation alters the usual anatomy. Especially when performing laparoscopic cholecystectomy. Subtotal laporoscopic cholecystectomy provides a solution by permitting near-total gallbladder removal and thorough stone evacuation, thus bypassing dissection in dangerous regions. The aim of this study was to analyze our clinical experience with LSC in respect to safety, early and long-term outcomes. Methods. We analyzed the operative records of 7188 patients who underwent LC from January 2005 to September 2019 in our clinic. In the first period from 2005 to 2008, in patients with technically difficult cases (Grade 3,4 Nassar) we performed conversion to open procedure, in the second period from 2009 to 2019 in patients with technically difficult cases (Grade 3,4 Nassar) we performed laparoscopic subtotal cholecystectomy instead of conversion to open procedure. Results. During the I period from 2005 to 2008 LC was performed in 2720 patients. Serious technical difficulties (Nasar, Grade 3-4) were seen in 127 patients (4,7 %), 57 (45%) men and 70 (55%) women. In the second period from 2009 to 2019 LC was performed in 4468 patients. There was no significant difference between patients operated in the first and second period.Technical difficulties (Nassar, Grade 4) were seen in 134 (3%) patients. Conclusion. Our study shows that LCS can be useful for the management of severe cholecystitis and difficult gallbladders. Our patients who underwent LCS had good outcomes with low incidence of complications. LCS is a safe alternative that minimizes the risk of bile duct and portal structure injuries. LCS is an effective technique in patients with severe inflammation of gallbladders and fibrosis of cystohepatic triangle. Using LCS can dramatically improve the results of laparoscopic operations in patients with gallbladder disease.