Laparoscopic subtotal cholecystectomy for severe cholecystitis.

BACKGROUND

In severe cholecystitis, laparoscopic cholecystectomy can be technically difficult, and is associated with an increased rate of procedure conversions and common bile duct lesions.

METHODS

We investigated the safety and complications of laparoscopic subtotal cholecystectomy for severe cholecystitis in a medium- to long-term follow-up evaluation. Laparoscopic cholecystectomy was performed in 345 patients during a period of 64 months. In 46 of the patients (13.3%), a subtotal cholecystectomy was performed. The results were compared with data on laparoscopic cholecystectomy from 16,130 patients in 84 surgical institutes in Switzerland, collected prospectively by the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTS).

RESULTS

The median operating time was 93 min (range, 50-140) min. The overall rate of procedure conversions in acute cholecystitis was lowered significantly from 23.2% (SALTS) to 9.7%. There was no bile duct lesion, as compared with the rate of 0.8% in the SALTS data. In follow-up evaluations, fluid collections in 16 patients (35%) and residual gallstones in 6 patients (13%) were of no clinical relevance.

CONCLUSIONS

Laparoscopic subtotal cholecystectomy for acute cholecystitis offers a simple and safe solution that prevents bile duct injuries and decreases the rate of conversion in anatomically difficult situations.