laparoscopic subtotal cholecystectomy a salvageable procedure in patients with comorbidities

Abstract

Aim: Our aim of study to show the feasibility and outcomes of laparoscopicsubtotal cholecystectomy in presence of difficult calot’s triangle anatomy, even inpresence of cormobidities.Materials & Methods: This study involved a retrospective analysis of patientsmanaged by laparoscopic subtotal cholecystectomy from January 2014 toDecember 2019. Here we analyzed the demography, indications, associated comorbidity,complications, management and their outcomes.Results: During this study period 53 cases underwent LSTC (laparoscopicsubtotal cholecystectomy), Median age of patients was 52 years (range 31-76years). 33 (62.26%) frozen calot’s triangle was the main peroperative findings inthese cases. The infundibulum of gall bladder was mainly managed byendosuturing 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 onesubhepatic drain placement, 1 case omentum sutured over the cystic duct stumpanother 1 case of cholecystoduodenal fistula was repair with vicryl 3-0. Therewere (n=18) type I, (n=24) type II, (n=11) type III laparoscopic subtotalcholecystectomy done in our study. Two (3.77%) patients had postoperativemorbidity. 1 (1.88%) case had a postoperative bile leak which was successfullymanaged by ERC and stenting. None of the case had a wound infection or intraabdominal collection; there was no mortality and no bile duct injury. The medianpostoperative stay was 4 days (range 2-16 days). The mean follow up durationwas 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 subtotalcholecystectomy is an effective and safe option, which shows excellentpostoperative recovery and ensures a satisfactory functional outcome for thepatient gall stone disease even in presence of comorbidities.Clinical Significance:KEYWORDSLaparoscopic cholecystectomy, Laparoscopic Subtotal cholecystectomy, difficult cholecystectomy.