Laparoscopic Partial Cholecystectomy: A Safe and Effective Alternative Surgical Technique in “Difficult Cholecystectomies”
Fatih Kulen, Deniz Tihan, Uğur Duman, Emrah Bayam, Gökhan Zaim
Clinic of General Surgery, Şevket Yılmaz Training and Research Hospital, Bursa, Turkey
Keywords: Cholelithiasis, laparoscopic partial cholecystectomy, difficult cholecystectomy, conversion cholecystectomy, safe cholecystectomy, bile duct injury
Objective: Laparoscopic cholecystectomy has become the ‘’gold standard‘’ for benign gallbladder diseases due to its advantages. In the presence of inflammation or fibrosis, the risk of bleeding and bile duct injury is increased during dissection. Laparoscopic partial cholecystectomy (LPC) is a feasible and safe method to prevent bile duct injuries and decrease the conversion (to open cholecystectomy) rates in difficult cholecystectomies where anatomical structures could not be demonstrated clearly.
Material and Methods: The feasibility, efficiency, and safety of LPC were investigated. The data of 80 patients with cholelithiasis who underwent LPC (n=40) and conversion cholecystectomy (CC) (n=40) were retrospectively examined. Demographic characteristics, ASA scores, operating time, drain usage, requirement for intensive care, postoperative length of hospital stay, surgical site infection, antibiotic requirement and complication rates were compared.
Results: The median ASA value was 1 in the CC group and 2 in the LPC group. Mean operation time was 123 minutes in the CC group, and 87.50 minutes in the LPC group. Surgical drains were used in 16 CC patients and 4 LPC patients. There was no significant difference between groups in postoperative length of intensive care unit stay (p=0.241). When surgical site infections were compared, the difference was at the limit of statistical significance (p=0.055). Early complication rates were not different (p=0.608) but none of the patients in the LPC group suffered from late complications.
Conclusion: LPC is an efficient and safe way to decrease the conversion rate. LPC seems to be an alternative procedure to CC with advantages of shorter operating time, lower rates of surgical site infection, shorter postoperative hospitalization and fewer complications in high-risk patients.
Ethics Committee approval was not required as the study was retrospective.
Written informed consent was obtained from patients who participated in this study.
Concept - F.K., D.T.; Design - D.T., A.D.; Supervision - D.T., A.D., M.P.; Resources - F.K., D.T., U.D.; Materials - U.D., G.Z.; Data Collection and/or Processing - D.T., U.D., G.Z.; Analysis and/or Interpretation - F.K., D.T., U.D.; Literature Search - E.B.; Writing Manuscript - F.K., D.T., U.D.; Critical Review - E.B., A.D., M.P.; Other - E.B., G.Z.
No conflict of interest was declared by the authors.
The authors declared that this study has received no financial support.