Journal of Surgery

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Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis

Received: 29 September 2017    Accepted: 10 October 2017    Published: 12 November 2017
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Abstract

Background: When the critical view of safety (CVS) can't be obtained during dissection of Calot’s triangle in difficult gallbladder, conversion to open surgery or other “damage control” alternatives as cholecystostomy and subtotal cholecystectomy are recommended to prevent bile duct injury. Materials and methods: The medical records of all patients presented with acute calculous cholecystitis (ACC) during the study period were retrospectively reviewed and analyzed. Results: Laparoscopic cholecystectomy (LC) was attempted in 71 difficult gallbladders out of 379 patients presenting with ACC. In 6 patients (8.5%), conversion to open surgery or laparoscopic cholecystostomy was performed. Laparoscopic subtotal cholecystectomy (LSC) with dissection and control of the cystic duct was performed for the remaining 65 patients (91.5%) including 50 females (77%) and 15 males (23%) with a mean age of 42.35±12.4 years. The mean operative blood loss was 45.28±18.6 CC and the mean operative time was 96.3±24.19 minutes. There were no operative complications or mortality. The mean hospital stay was 28±17.8 hours. There was no postoperative jaundice, bile leak, intra-abdominal collections or mortality. Conclusion: When surgery is indicated for difficult ACC, LSC with control of the cystic duct is safe with excellent outcomes. However, if the CVS can’t be achieved due to obscured anatomy at Calot’s triangle, conversion to open surgery or cholecystostomy must be performed to prevent bile duct injury.

DOI 10.11648/j.js.20170506.15
Published in Journal of Surgery (Volume 5, Issue 6, December 2017)
Page(s) 111-117
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Subtotal Cholecystectomy, Laparoscopy, Acute Calculous Cholecystitis

References
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[2] Buddingh KT, Hofker HS, ten Cate Hoedemaker HO, et al (2011) Safety measures during cholecystectomy: results of a nationwide survey. World J Surg 35:1235–1241.
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Author Information
  • General Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt

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    Hamdy Sedky Abdallah. (2017). Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis. Journal of Surgery, 5(6), 111-117. https://doi.org/10.11648/j.js.20170506.15

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    Hamdy Sedky Abdallah. Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis. J. Surg. 2017, 5(6), 111-117. doi: 10.11648/j.js.20170506.15

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    AMA Style

    Hamdy Sedky Abdallah. Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis. J Surg. 2017;5(6):111-117. doi: 10.11648/j.js.20170506.15

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  • @article{10.11648/j.js.20170506.15,
      author = {Hamdy Sedky Abdallah},
      title = {Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis},
      journal = {Journal of Surgery},
      volume = {5},
      number = {6},
      pages = {111-117},
      doi = {10.11648/j.js.20170506.15},
      url = {https://doi.org/10.11648/j.js.20170506.15},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.js.20170506.15},
      abstract = {Background: When the critical view of safety (CVS) can't be obtained during dissection of Calot’s triangle in difficult gallbladder, conversion to open surgery or other “damage control” alternatives as cholecystostomy and subtotal cholecystectomy are recommended to prevent bile duct injury. Materials and methods: The medical records of all patients presented with acute calculous cholecystitis (ACC) during the study period were retrospectively reviewed and analyzed. Results: Laparoscopic cholecystectomy (LC) was attempted in 71 difficult gallbladders out of 379 patients presenting with ACC. In 6 patients (8.5%), conversion to open surgery or laparoscopic cholecystostomy was performed. Laparoscopic subtotal cholecystectomy (LSC) with dissection and control of the cystic duct was performed for the remaining 65 patients (91.5%) including 50 females (77%) and 15 males (23%) with a mean age of 42.35±12.4 years. The mean operative blood loss was 45.28±18.6 CC and the mean operative time was 96.3±24.19 minutes. There were no operative complications or mortality. The mean hospital stay was 28±17.8 hours. There was no postoperative jaundice, bile leak, intra-abdominal collections or mortality. Conclusion: When surgery is indicated for difficult ACC, LSC with control of the cystic duct is safe with excellent outcomes. However, if the CVS can’t be achieved due to obscured anatomy at Calot’s triangle, conversion to open surgery or cholecystostomy must be performed to prevent bile duct injury.},
     year = {2017}
    }
    

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    T1  - Laparoscopic Subtotal Cholecystectomy for Difficult Acute Calculous Cholecystitis
    AU  - Hamdy Sedky Abdallah
    Y1  - 2017/11/12
    PY  - 2017
    N1  - https://doi.org/10.11648/j.js.20170506.15
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    AB  - Background: When the critical view of safety (CVS) can't be obtained during dissection of Calot’s triangle in difficult gallbladder, conversion to open surgery or other “damage control” alternatives as cholecystostomy and subtotal cholecystectomy are recommended to prevent bile duct injury. Materials and methods: The medical records of all patients presented with acute calculous cholecystitis (ACC) during the study period were retrospectively reviewed and analyzed. Results: Laparoscopic cholecystectomy (LC) was attempted in 71 difficult gallbladders out of 379 patients presenting with ACC. In 6 patients (8.5%), conversion to open surgery or laparoscopic cholecystostomy was performed. Laparoscopic subtotal cholecystectomy (LSC) with dissection and control of the cystic duct was performed for the remaining 65 patients (91.5%) including 50 females (77%) and 15 males (23%) with a mean age of 42.35±12.4 years. The mean operative blood loss was 45.28±18.6 CC and the mean operative time was 96.3±24.19 minutes. There were no operative complications or mortality. The mean hospital stay was 28±17.8 hours. There was no postoperative jaundice, bile leak, intra-abdominal collections or mortality. Conclusion: When surgery is indicated for difficult ACC, LSC with control of the cystic duct is safe with excellent outcomes. However, if the CVS can’t be achieved due to obscured anatomy at Calot’s triangle, conversion to open surgery or cholecystostomy must be performed to prevent bile duct injury.
    VL  - 5
    IS  - 6
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