Introduction Around 60,000 laparoscopic cholecystectomies are performed each year in the UK. Increasingly patients are being operated on during periods of active gallbladder inflammation. Identification of the anatomy can prove challenging during a “hot” cholecystectomy. Sub-total cholecystectomy is an increasingly accepted method of minimising operative complications for patients with complicated cholecystitis. The aim of the study is to determine whether complications can be kept to a minimum without needing to perform an open procedure.
Method Retrospective analysis of 32 patients’ cases who underwent sub-total cholecystectomy in a District General hospital between 01/2011 and 12/2014.
Results During the study period 840 cholecystectomies were performed in 664 women (79.0%) and 176 men (21.0%). 32 subtotal cholecystectomies were performed (3.8%, 31 laparoscopic, 1 lap converted to open). 808 total cholecystectomies were performed (96.2%, 1 open, 3 lap converted to open). 132 cases (15.7%) were performed as ‘hot’ emergency or urgent procedures. 155 patients (18.1%) underwent on table cholangiograms. No bile duct injuries and 1 bile leak occurred in the total cholecystectomy population.
In the subtotal cholecystectomy cohort there were 21 men and 11 women with a median age of 69 (range 44–83). 25 patients presented with cholecystitis, 2 with biliary colic, 4 with cholangitis and one with pancreatitis. 11 were performed as ‘hot’ emergency or urgent procedures (34%).
Despite this, active inflammation was present in 24 cases. Empyema was present in five patients. Four gallbladders’ were perforated. 30 pts had sub-hepatic drain insertion. Of these, 7 were removed in clinic post discharge. Median time to drain removal was 2 days (range 1–15 days). Median length of stay was 2 day (range 1–19).
No bile duct injuries occurred. 1 bile leak occurred and required ERCP and stent. 3 patients developed post operative abscesses. One patients required laparoscopy and washout, one required a radiologically inserted drain and was managed conservatively with IV antibiotics. 8 patients received a single follow up in clinic (range 6 days – 3 months). 2 patients were re-referred to clinic from primary care with on-going symptoms. Of these, one required laparoscopic completion cholecystectomy 13 months following the original procedure. Another suffered cholangitis attributed to pre-operative ERCP and sphincterotomy, managed conservatively.
Conclusion In the context of indefinable anatomy, laparoscopic sub-total cholecystectomy with retrograde dissection is a safe procedure with minimal complications. It is sufficient management in the majority patients. It allows for safer re-intervention in the small proportion of patients suffering from ongoing biliary symptoms.
Disclosure of interest None Declared.
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