Surgery today · 2009
Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury: experience of a hospital in northern China.
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Tian Yu, Wu Shuo-Dong, Su Yang, Kong Jing, Yu Hong, Fan Ying
Аннотация
PURPOSE: Experience and advances in laparoscopic techniques have made laparoscopic subtotal cholecystectomy (LSTC) a feasible option even in complex procedures. We report our experience of performing LSTC in the management of complicated cholecystitis.
METHODS: Among 1558 patients scheduled to undergo laparoscopic cholecystectomy (LC) in our institute between July 2004 and December 2007, 48 underwent LSTC for complicated cholecystitis. We describe our tailored approach and the techniques we used to accomplish this.
RESULTS: All 48 patients underwent retrograde cholecystectomy. Twenty (41.6%) required an additional port (the fourth port) to obtain adequate exposure of the hilum, 39 (81.3%) required suturing of the gallbladder infundibular remnant, and 4 (8.33%) experienced local complications. The mean operative time of LSTC was 61.7 +/- 17.5 min, the estimated operative blood loss was 72.0 +/- 32.8 ml, the time to resume oral intake was 27.8 +/- 14.9 h, and the mean postoperative hospital stay was 4.5 +/- 1.3 days. There was no bile duct injury or mortality in this series.
CONCLUSION: Laparoscopic subtotal cholecystectomy is a safe and feasible alternative to conversion to open surgery during difficult laparoscopic cholecystectomy for patients with complicated cholecystitis. However, we emphasize that only experienced laparoscopic surgeons should perform this procedure when complete removal of the gallbladder is not possible.
METHODS: Among 1558 patients scheduled to undergo laparoscopic cholecystectomy (LC) in our institute between July 2004 and December 2007, 48 underwent LSTC for complicated cholecystitis. We describe our tailored approach and the techniques we used to accomplish this.
RESULTS: All 48 patients underwent retrograde cholecystectomy. Twenty (41.6%) required an additional port (the fourth port) to obtain adequate exposure of the hilum, 39 (81.3%) required suturing of the gallbladder infundibular remnant, and 4 (8.33%) experienced local complications. The mean operative time of LSTC was 61.7 +/- 17.5 min, the estimated operative blood loss was 72.0 +/- 32.8 ml, the time to resume oral intake was 27.8 +/- 14.9 h, and the mean postoperative hospital stay was 4.5 +/- 1.3 days. There was no bile duct injury or mortality in this series.
CONCLUSION: Laparoscopic subtotal cholecystectomy is a safe and feasible alternative to conversion to open surgery during difficult laparoscopic cholecystectomy for patients with complicated cholecystitis. However, we emphasize that only experienced laparoscopic surgeons should perform this procedure when complete removal of the gallbladder is not possible.