Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis

Michałowski, K; Bornman, Philippus C.; Krige, J. E. J.; Gallagher, P. J.; Terblanche, J.

doi:10.1046/j.1365-2168.1998.00749.x

Cited by 105 publications

(84 citation statements)

References 8 publications

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“…Subtotal cholecystectomy has been recommended as a safe and viable option in patients where anatomical distortion at Calot's triangle precludes a safe dissection [7,8,[13][14][15]. Conversion rate to open surgery is higher for patients with acute cholecystitis than in those without acute cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

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Residual gallstone disease — Laparoscopic management

et al. 2010

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Section: Discussionmentioning

confidence: 99%

“…The condition may arise as a result of inadequate dissection of cystic duct or a partial or ORIGINAL ARTICLE subtotal cholecystectomy. Patients with severe anatomical distortion, tissue friability or poor general condition are often managed by performing a salvage partial cholecystectomy or a cholecystostomy [6][7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Residual gallstone disease — Laparoscopic management

et al. 2010

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“…3 Laparoscopic surgery for biliary calculi has come a long way, and with it newer modifications such as the subtotal cholecystectomy. 4 Laparoscopic surgery for the removal of calculi of the cystic duct remnant has rarely been reported. 5 We present our experience of patients with calculi of the cystic duct remnant that successfully underwent laparoscopic extraction.…”

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confidence: 99%

Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study

Palanivelu

Rangarajan

Jategaonkar

et al. 2009

annals

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INTRODUCTION Even though cholecystectomy relieves symptoms in the majority of cases, a significant percentage suffer from 'post-cholecystectomy syndrome'. Cystic duct/gall bladder remnant calculi is a causative factor. We present our experience with the laparoscopic management of cystic duct remnant calculi. PATIENTS AND METHODS We managed 15 patients with cystic duct remnant calculi from 1996 to 2007 in our institute. All these patients had earlier undergone laparoscopic subtotal cholecystectomy at our centre. They were successfully managed by laparoscopic excision of the remnant. RESULTS The mean duration between first and second surgery was 8.35 months (range, 6-10.7 months). The mean operating time was 103.5 min (range, 75-132 min). Duration of hospital stay was 4-12 days. There was a higher incidence of remnant duct calculi following laparoscopic subtotal cholecystectomy than conventional laparoscopic cholecystectomy -13/310 (4.19%) versus 2/9590 (0.02%). The morbidity was 13.33%, while there were no conversions and no mortality. CONCLUSIONS Leaving behind a cystic duct stump for too long predisposes stone formation, while dissecting too close to the common bile duct and right hepatic artery in acute inflammatory conditions is dangerous. We believe that the former is a wiser policy to follow, as cystic duct remnant calculi are easier to manage than common bile duct or vessel injury. Laparoscopic excision of the remnant is effective, especially when performed by experienced laparoscopists. 'T'-tube is used to canulate the common bile duct in case the tissue is friable. Magnetic resonance cholangiopancreaticography is the imaging modality of choice, and is mandatory.

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“…The later was included under the subheading of "multiple causes." For empyema gallbladder, endo-knotting the cystic duct either with silk or preformed endoloops and using the technique of laparoscopic subtotal cholecystectomy as described by some authors could definitely prevent conversions and complications in some cases [12,16]. Slow diffuse ooze from liver bed was sometimes made worse by conventional electrocautery.…”

Section: Discussionmentioning

confidence: 99%

“Laparoscopic Cholecystectomy: A Single Surgeon’s Experience in some of the Teaching Hospitals of West Bengal”

et al. 2013

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Laparoscopic cholecystectomy has revolutionized the management of symptomatic gallstone disease since its introduction more than 20 years ago. It has gained widespread acceptance and is presently the gold standard for its management. This large study spanned over last 10 years and includes prospective data on 950 elective cases of laparoscopic cholecystectomy since 2002. All cases were operated personally by the author in different teaching hospitals of West Bengal. The following were looked into: profiles of the patients including major comorbidities requiring special precautions, the frequency of "difficult cholecystectomies," conversion rate, and operative and postoperative complications. The results showed that 75 % of the patients were females. The mean age of the female patients was 35 years (range15-75), while that of the male patients was 42 (range 18-68). Thirty-two patients had major comorbidities which required special precautions in the perioperative period. Twenty-six percent of the cases were categorized as "difficult," and 6 % of the cases had to be converted to open procedure. Major complications occurred in 11 patients of which five had to be converted. Fiftyfive patients had port-site infection due to atypical mycobacteria species of which majority occurred in the last 1 year of the study. All of them responded to second-line antitubercular medications.

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Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis

Abstract: LSC is a safe, relatively simple and definitive procedure allowing removal of a difficult gallbladder and reducing the need for open conversion or cholecystostomy in the majority of patients.

Cited by 105 publications

References 8 publications

Residual gallstone disease — Laparoscopic management

Residual gallstone disease — Laparoscopic management

Laparoscopic Management of Remnant Cystic Duct Calculi: A Retrospective Study

“Laparoscopic Cholecystectomy: A Single Surgeon’s Experience in some of the Teaching Hospitals of West Bengal”

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