Safty and Complications of Laparoscopic Subtotal Cholecystectomy for Severe Cholecystitis

Shunichiro Komatsu, Hiroshi Hasegawa, Takashi Shiroko, Eiji Sakamoto, Yasuhiro Kurumiya, Shinji Norimizu, Tomotake Tabata, Seiji Natsume and Taro Aoba

Department of Surgery, Nagoya Daini Red Cross Hospital

We assessed the safety of laparoscopic subtotal cholecystectomy (LSC) in patients with complicated severe cholecystitis or fibrosis. Laparoscopic cholecystectomy was conducted in 750 patients during 3 years and 8 months. Of these 25 required LSC, because dissection of Calot's triangle would be dangerous. The gallbladder was divided from the liver bed fundus first, followed by subtotal gallbladder removal and closure of the remnant, using an endoscopic linear stapler (ELS) or using laparoscopic suture and ligation. The gallbladder was incised, at the level of Hartmann's pouch to confirm its location, to remove contents, or to conduct intraoperative cholangiography through the cystic duct orifice, when necessary. The gallbladder mucosa left on the liver bed was ablated. No cases required conversion to laparotomy. The gallbladder neck was closed by ELS in 19 and by laparoscopic suturing in 6. Mean operating time was 143 minutes, and mean postoperative hospitalization 5.2 days. We found a case of delayed bile leakage and another of choledocholithiasis due to residual gallstones. In one case, we found incidental gallbladder cancer. LSC for severe cholecystitis appears to be safe in avoiding serious complications, such as bile duct injury.

Key words
laparoscopic cholecystectomy, bile duct injury, gallbladder cancer

Reprint requests
Shunichiro Komatsu Department of Surgery, Nagoya Daini Red Cross Hospital
2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650 JAPAN

Accepted
February 20, 2008

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