Endo-loop or interrupted suture closure of gallbladder remnant during laparoscopic subtotal cholecystectomy- a retrospective analysis of our experience at a high-volume centre of Eastern Nepal.

INTRODUCTION

Subtotal laparoscopic cholecystectomy (LSC) is a rescue procedure in difficult case, retaining all advantages of minimally invasive surgery. The most reputed definition of subtotal cholecystectomy is the removal of 3/4th of gallbladder with closure of the infundibulum. The closure of the infundibulum can be with either intracorporeal interrupted suture or pre-knotted endo-loop. This study aims to share our experience with the stump closure techniques (either interrupted suture closure or endo-loop closure) during LSC so that the result of the study helps surgeons to choose an appropriate technique of the stump closure.

METHODS

This study includes patients with indications for laparoscopic cholecystectomy but who underwent LSC (Henneman's type C) because of intraoperative findings over last 5-years(2019-2024AD) in BPKIHS, a high-volume centre of the eastern Nepal.

RESULTS

Over last 5-years period, a total of 4578 laparoscopic cholecystectomies were performed, 120(2.6%) of which were subtotal. The patients who underwent LSC had male predominance with male/female ratio of 1.3:1 with mean age of 55.53 ± 7.45years (37-71 years). The most common pre-operative diagnosis in these patients who underwent LSC was uncomplicated gall bladder stone in 55(45.5%) patients and intraoperative finding was the frozen Calot in 50(41.7%) patients. Operative time (126.76 ± 26.85 versus 158.65 ± 17.15 min), intraoperative blood loss (210.29 ± 30.56 versus 246.15 ± 28.29 ml), minor stump leak rate (0/68 versus 20/52), length of hospital stay (2.78 ± 0.83 versus 3.58 ± 1.35days) and duration of the drain (5.97 ± 2.75 versus 9 ± 3.55 days) were significantly lower in the stump closure with endo-loop group in comparison to the stump closure with interrupted suture group with p-value < 0.05.

CONCLUSION

Nowadays, LSC is gaining preference over conversion to open procedure in difficult cholecystectomy cases. It is better to close the remnant stump of gallbladder with endo-loop to decrease biliary leak with addition advantage of shorter operative time, lesser intraoperative blood loss, shorter length of hospital stays and shorter duration of the drain placement. We recommend to close the remnant stump with endo-loop if the remnant stump is mobilized all around with intact and adequate length of all sides (including posterior one). However, the stump closure with interrupted suture should be opted if above mentioned criteria are not achieved.