Laparoscopic partial cholecystectomy: A way of getting out of trouble

Peter Daechul Yoon ； Tony Pang ； Mehan Siriwardhane ； Arthur Richardson ； Michael Hollands ； Henry Pleass ； Emma Johnston ； Lawrence Yuen ； Vincent Lam

《International Journal of Hepatobiliary and Pancreatic Diseases(IJHPD)》 6卷2期 (2016/12) Pp. 68-75

https://doi.org/10.5348/ijhpd-2016-57-OA-13

摘要

Aims: Laparoscopic cholecystectomy (LC) is currently the standard treatment for symptomatic gallstones. In the presence of moderate to severe inflammation when dissection of the cholecystohepatic triangle cannot be safely achieved, laparoscopic partial cholecystectomy (LPC) has been proposed as an alternative to open conversion to prevent bile duct injuries. The aim of this study is to review our experience of the technique. Materials and Methods: A retrospective review of all patients who underwent laparoscopic cholecystectomy under the upper gastrointestinal surgical unit at Westmead Hospital was undertaken. The study included all emergency and elective cases during a period from February 2012 to February 2014. Demographic, clinical, operative and postoperative characteristics including operative technique, placement of a drain, complications, length of hospital stay and histopathology were collected. Results: A total of 404 patients underwent LC during the two year study period of which 23 were LPC's. Patients who underwent LPC tended to be older and more likely of the male gender. These patients were also more likely to be an emergency operation and have a higher ASA grade compared to the LC group. Length of stay and operative time tended to be longer. There were five (22%) bile leaks postoperatively and all were successfully managed with postoperative ERCP and stenting. The major complication rate was 35% (8/23) with no bile duct injury or perioperative mortality. Conclusion: This current case series adds further evidence to suggest that LPC is a viable alternative to conversion in cases of difficult LC.

關鍵字

Cholecystitis ； Laparoscopic cholecystectomy ； Partial cholecystectomy ； Subtotal cholecystectomy