laparoscopic subtotal cholecystectomy a salvageable procedure in patients with comorbidities

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Ashok Kumar*, Shomnath Reddy, Anu behari, V.K kapoor, Anand Prakash, “laparoscopic subtotal cholecystectomy a salvageable procedure in patients with comorbidities”, ijmhs, vol. 10, no. 03, pp. 862–870, Mar. 2020.
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Abstract


Aim: Our aim of study to show the feasibility and outcomes of laparoscopic
subtotal cholecystectomy in presence of difficult calot’s triangle anatomy, even in
presence of cormobidities.
Materials & Methods: This study involved a retrospective analysis of patients
managed by laparoscopic subtotal cholecystectomy from January 2014 to
December 2019. Here we analyzed the demography, indications, associated comorbidity,
complications, management and their outcomes.
Results: During this study period 53 cases underwent LSTC (laparoscopic
subtotal cholecystectomy), Median age of patients was 52 years (range 31-76
years). 33 (62.26%) frozen calot’s triangle was the main peroperative findings in
these cases. The infundibulum of gall bladder was mainly managed by
endosuturing of the stump (n=21) rest of cases managed by an Endo GIA (n=7),
serial metallic clipping (n=2) and in 4 cases stump was left unsutured with one
subhepatic drain placement, 1 case omentum sutured over the cystic duct stump
another 1 case of cholecystoduodenal fistula was repair with vicryl 3-0. There
were (n=18) type I, (n=24) type II, (n=11) type III laparoscopic subtotal
cholecystectomy done in our study. Two (3.77%) patients had postoperative
morbidity. 1 (1.88%) case had a postoperative bile leak which was successfully
managed by ERC and stenting. None of the case had a wound infection or intra
abdominal collection; there was no mortality and no bile duct injury. The median
postoperative stay was 4 days (range 2-16 days). The mean follow up duration
was 60 months and the outcome was excellent in all the patients.
Abbreviation: ERC (Endoscopic Retrograde Cholangiography), LSC
(Laparoscopic Subtotal Cholecystectomy), GB (Gall Bladder),
Conclusions: In scenario of difficult calot’s triangle, laparoscopic subtotal
cholecystectomy is an effective and safe option, which shows excellent
postoperative recovery and ensures a satisfactory functional outcome for the
patient gall stone disease even in presence of comorbidities.
Clinical Significance:
KEYWORDS
Laparoscopic cholecystectomy, Laparoscopic Subtotal cholecystectomy, difficult cholecystectomy.

KEYWORDS:

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References

1.Shikata S, Noguchi Y, Fukui T. Earlyversus delayed cholecystectomy for acutecholecystitis: A meta-analysis ofrandomized controlled trials. Surg Today.2005; 35: 553-560. 2.Soper NJ, Brunt LM, Callery MP,Edmundowicz SA, Aliperti G. Role oflaparoscopic cholecystectomy in themanagement of acute gall stonepancreatitis. Am J Surg. 1994; 167:42-50. 3.Blum CA, Adams DB. Who did the firstlaparoscopic cholecystectomy? J MinimAccess Surg. 2011; 7:165-8. 4.Madding GF. Subtotal cholecystectomyin acute cholecystitis. AmJ Surg. 1955;89 : 604-607.5.Philips JA, Lawes DA, Cook AJ,Arulampalam TH, Zaborsky A, MenziesD, et al. The use of laparoscopic subtotalcholecystectomy for complicatedcholelithiasis. SurgEndosc. 2008;22:1697–1700.[PubMed] [Google Scholar] 6.Palanivelu C, Rangarajan M, JategaonkarPA, Madankumar MV, Anand NV.Laparoscopic management of remnantcystic duct calculi: A retrospectivestudy. Ann R CollSurg Engl. 2009;91:25–29.[PMCfree article] [PubMed] [Google Scholar7.Michalowski K, Bornman PC, Krige JE,Gallagher PJ, Terblanche J. Laparoscopicsubtotal cholecystectomy in patients withcomplicated acute cholecystitis orfibrosis. Br J Surg. 1998;85:904–906.[PubMed] [Google Scholar] 8.Beldi G, Glattli A. Laparoscopic subtotalcholecystectomy for severe cholecystitis.Surg Endosc. 2003; 17:1437-9. 9.Chowbey PK, Sharma A, Khullar R,Mann V, Baijal M, Vashistha A.laparoscopic subtotal cholecystectomy: Areview of 56 procedures. J LaparoendoscAdv Surg Tech A. 2000; 10:31-4. 10 10.Roslyn JJ, Binns GS, HughesEF, Saunders-Kirkwood K,Zinner MJ, Cates JA.Open cholecystectomy. Acontemporary analysis of 42,474 patients. Ann Surg 1993; 218:129-37. 11.Sanabria JR, Clavien PA, Cywes R,Strasberg SM. Laparoscopic versus opencholecystectomy: A matched study. Can JSurg 1993; 36:330-6. 12.Chowbey PK, Sharma A, Khullar R,Mann V, Baijal M, Vashistha A.laparoscopic subtotal cholecystectomy:are-view of 56 procedures. J LaparoendoscAdv Surg Tech A. 2000; 10:31-34. 13.Dilip Gode, C. Palanivelu, ZahiruddinQuazi Syed. New variants oflaparoscopic subtotal cholecystectomy inmanagement of acute cholecystitis. Int JMed Sci Public Health. 2014; 3: 397-400. 14.Ibrarullah MD, Kacker LK, Sikora SS,Saxena R, Kapoor VK, Kaushik SP.Partial cholecystectomy safe andeffective. HPB Surg. 1993;7:61–65.[PubMed] [Google Scholar] 15.Ji W, Li LT, Li JS. Role of laparoscopicsubtotal cholecystectomy in the treatmentof complicatedcholecystitis. Hepatobiliary Pancreat DisInt. 2006; 5:584–589. [PubMed] [GoogleScholar] 16.Hosni Mubarak Khan, Manjunath B. G,Vasanth G. Shenoy. Laparoscopicsubtotal cholecystectomy: a safeapproach. Int Surg J. 2019 May;6: 1767-1771. 17.Philips JA, Lawes DA, Cook AJ,Arulampalam TH, Zaborsky A, Menzies D, et al. The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc. 2008; 22:1697-700. 18.Henneman D, da Costa DW, VrouenraetsBC, van Wagensveld BA, Lagarde SM.Laparoscopic partial cholecystectomy forthe difficult gallbladder: A systematicreview. Surg Endosc 2013; 27:315-58. 19.Ouchi K, Mikuni J, Kakugawa Y,Organizing Committee of the 30thAnnual Congress of the Japanese Societyof Biliary Surgery Laparoscopiccholecystectomy for gallbladdercarcinoma: results of a Japanese surveyof 498 patients. J Hepatobiliary PancreatSurg. 2002; 9:256-60. 20.Yamamoto H, Hayakawa N, Kitagawa Y,Katohno Y, Sasaya T. Unsuspectedgallbladder carcinoma after laparoscopiccholecystectomy. J HepatobillaryPancreat Surg. 2005; 12:391-8. 21.Singh A, Kapoor A, Singh RK, PrakashA, Behari A, Kumar A, et al.Management of residual gall bladder: A15-year experience from a north Indiantertiary care centre. Ann HepatobiliaryPancreat Surg. 2018; 22:36–41. 22.Kapoor VK, Singh R, Behari A, SharmaS, Kumar A, Prakash A, et al. Anticipatory Extended Cholecystectomy. The Lucknow Approach for Thick Walled Gall Bladder with Low Suspicion of Cancer. Chin Clin Oncol. 2016; 5:8. doi: 10.3978/j.issn.2304-3865.2016.02.07

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References

1.Shikata S, Noguchi Y, Fukui T. Earlyversus delayed cholecystectomy for acutecholecystitis: A meta-analysis ofrandomized controlled trials. Surg Today.2005; 35: 553-560.
2.Soper NJ, Brunt LM, Callery MP,Edmundowicz SA, Aliperti G. Role oflaparoscopic cholecystectomy in themanagement of acute gall stonepancreatitis. Am J Surg. 1994; 167:42-50.
3.Blum CA, Adams DB. Who did the firstlaparoscopic cholecystectomy? J MinimAccess Surg. 2011; 7:165-8.
4.Madding GF. Subtotal cholecystectomyin acute cholecystitis. AmJ Surg. 1955;89 : 604-607.5.Philips JA, Lawes DA, Cook AJ,Arulampalam TH, Zaborsky A, MenziesD, et al. The use of laparoscopic subtotalcholecystectomy for complicatedcholelithiasis. SurgEndosc. 2008;22:1697–1700.[PubMed] [Google Scholar]
6.Palanivelu C, Rangarajan M, JategaonkarPA, Madankumar MV, Anand NV.Laparoscopic management of remnantcystic duct calculi: A retrospectivestudy. Ann R CollSurg Engl. 2009;91:25–29.[PMCfree article] [PubMed] [Google Scholar7.Michalowski K, Bornman PC, Krige JE,Gallagher PJ, Terblanche J. Laparoscopicsubtotal cholecystectomy in patients withcomplicated acute cholecystitis orfibrosis. Br J Surg. 1998;85:904–906.[PubMed] [Google Scholar]
8.Beldi G, Glattli A. Laparoscopic subtotalcholecystectomy for severe cholecystitis.Surg Endosc. 2003; 17:1437-9.
9.Chowbey PK, Sharma A, Khullar R,Mann V, Baijal M, Vashistha A.laparoscopic subtotal cholecystectomy: Areview of 56 procedures. J LaparoendoscAdv Surg Tech A. 2000; 10:31-4. 10
10.Roslyn JJ, Binns GS, HughesEF, Saunders-Kirkwood K,Zinner MJ, Cates JA.Open cholecystectomy. Acontemporary analysis of 42,474 patients. Ann Surg 1993; 218:129-37.
11.Sanabria JR, Clavien PA, Cywes R,Strasberg SM. Laparoscopic versus opencholecystectomy: A matched study. Can JSurg 1993; 36:330-6.
12.Chowbey PK, Sharma A, Khullar R,Mann V, Baijal M, Vashistha A.laparoscopic subtotal cholecystectomy:are-view of 56 procedures. J LaparoendoscAdv Surg Tech A. 2000; 10:31-34.
13.Dilip Gode, C. Palanivelu, ZahiruddinQuazi Syed. New variants oflaparoscopic subtotal cholecystectomy inmanagement of acute cholecystitis. Int JMed Sci Public Health. 2014; 3: 397-400.
14.Ibrarullah MD, Kacker LK, Sikora SS,Saxena R, Kapoor VK, Kaushik SP.Partial cholecystectomy safe andeffective. HPB Surg. 1993;7:61–65.[PubMed] [Google Scholar]
15.Ji W, Li LT, Li JS. Role of laparoscopicsubtotal cholecystectomy in the treatmentof complicatedcholecystitis. Hepatobiliary Pancreat DisInt. 2006; 5:584–589. [PubMed] [GoogleScholar]
16.Hosni Mubarak Khan, Manjunath B. G,Vasanth G. Shenoy. Laparoscopicsubtotal cholecystectomy: a safeapproach. Int Surg J. 2019 May;6: 1767-1771.
17.Philips JA, Lawes DA, Cook AJ,Arulampalam TH, Zaborsky A, Menzies
D, et al. The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc. 2008; 22:1697-700.
18.Henneman D, da Costa DW, VrouenraetsBC, van Wagensveld BA, Lagarde SM.Laparoscopic partial cholecystectomy forthe difficult gallbladder: A systematicreview. Surg Endosc 2013; 27:315-58.
19.Ouchi K, Mikuni J, Kakugawa Y,Organizing Committee of the 30thAnnual Congress of the Japanese Societyof Biliary Surgery Laparoscopiccholecystectomy for gallbladdercarcinoma: results of a Japanese surveyof 498 patients. J Hepatobiliary PancreatSurg. 2002; 9:256-60.
20.Yamamoto H, Hayakawa N, Kitagawa Y,Katohno Y, Sasaya T. Unsuspectedgallbladder carcinoma after laparoscopiccholecystectomy. J HepatobillaryPancreat Surg. 2005; 12:391-8.
21.Singh A, Kapoor A, Singh RK, PrakashA, Behari A, Kumar A, et al.Management of residual gall bladder: A15-year experience from a north Indiantertiary care centre. Ann HepatobiliaryPancreat Surg. 2018; 22:36–41.
22.Kapoor VK, Singh R, Behari A, SharmaS, Kumar A, Prakash A, et al. Anticipatory Extended Cholecystectomy. The Lucknow Approach for Thick Walled Gall Bladder with Low Suspicion of Cancer. Chin Clin Oncol. 2016; 5:8. doi: 10.3978/j.issn.2304-3865.2016.02.07

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