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:
Laparoscopic cholecystectomy, Laparoscopic Subtotal cholecystectomy, difficult