Partial Cholecystectomy Safe and Effective

Abstract

Patients undergoing surgical treatment for calculous disease were considered to have had a partial cholecystectomy performed when a part of the gall bladder wall was retained for technical reasons. Forty patients underwent partial cholecystectomy: for chronic cholecystitis (20), acute cholecystitis (4), Mirizzi's syndrome (14), portal hypertension or partially accesible gall bladder (one patient each). Four patients (10%) developed infective complications and two patients had retained common bile duct stones. In a mean follow up period of 13 months (range 1–36 mths), only 3 patients have ongoing mild dyspeptic symptoms while the rest have remained asymptomatic. Partial cholecystectomy has been found to be a safe and effective procedure in difficult cholecystectomy situations, since it combines the merits of cholecystectomy and cholecystostomy.

Laparoscopic subtotal cholecystectomy for severe cholecystitis

“…In earlier reports, the cystic bile duct was closed using a pursestring suture, clips, or an endoloop [3][4][5]7]. Chowbey et al [4], who published the largest laparoscopic subtotal cholecystectomy series, closed the cystic duct regularly using an Endo-GIA 30 (United States Surgical, Norwalk, CT) stapler, clips, or sutures.…”

The “inside approach of the gallbladder” is an alternative to the classic Calot’s triangle dissection for a safe operation in severe cholecystitis

“…At short-term follow-up (averaging 4.3 months), there were no infectious complications. By contrast, other series have reported septic abdominal complication rates varying from 1.5 to 10% [8,10,22,[26][27][28].…”

“…In addition, subtotal cholecystectomy has been reported to be a safe alternative to standard cholecystectomy, either open [8,[22][23][24] or laparoscopic [9,10,[24][25][26][27][28][29]. In the present series, the combined technique of endovesicular approach and SC was used in highly selective cholecystectomy cases, i.e., 7% of the study population, a rate similar to the 4-13.3% reported in the literature [9,[25][26][27][28][29].…”

Laparoscopic Completion Cholecystectomy for Post Cholecystectomy Syndrome

“…Other types of subtotal cholecystectomy have been described wherein the gallbladder was opened at the infundibulum, as close to the junction of the gallbladder and cystic duct as is safely possible, and the gallbladder flaps sutured after destroying the mucosa. [4,5] In these cases, there is always a stump of the gallbladder left behind that can cause problems, especially if care is not taken to destroy the mucosa and remove any calculi prior to its closure. It should also be kept in mind, especially in patients who have undergone laparoscopic cholecystectomy that a long cystic duct is normally left behind, since safety lies in staying away from the common bile duct and applying clips close to the gallbladder-cystic duct junction.…”