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ORIGINAL ARTICLE
Laparoscopic Subtotal Cholecystectomy: Our Experience

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George C Obonna , Martin C Obonna , Rajneesh K Mishra 3
AbstrAct
Background: The gold standard for gallbladder (GB) surgery worldwide is laparoscopic cholecystectomy. At the same time, complications that
may arise from performing cholecystectomy can be horrifying. This is because in some cases, the complex anatomy can predispose the patient
to the dangerous arteriovenous and biliary injuries. A subtotal cholecystectomy (STC) can, thus, obviate these complications.
Aim: To examine the clinical spectrum of STC and the postoperative turnout of this procedure.
Materials and methods: Our health management information system was used to collate our 10-year data (January 2010–January 2020) from
the secondary and tertiary health facilities owned by Ondo State of Nigeria. Information on patients’ biodata, indication for surgery, surgical
approach, laboratory evaluation, and radiological assessment was entered into a spreadsheet and analyzed using Statistical Package for the
Social Sciences (SPSS) version 20 (OBM Incorporation).
STC occurs when there is a remnant of the GB after GB surgery exclusive of the cystic duct.
Results: A total of 60 (15%) out of 400 patients underwent laparoscopic STC. Closely compacted, complexly crowded constituents and adhesions
at the Calot’s triangle were the main indications for STC. Ten patients (16.7%) had bile leakage after surgery. There were no biliovascular injuries,
and 1-month mortality was zero.
There was no case of surgical site infection. Over a consistent follow-up of 1 year, clinical examination, liver function test, and ultrasonography
revealed no abnormality in any of the patients.
Conclusion: STC is a rescue mission during difficult GB surgery. Early consideration for STC before conversion to open surgery is more acceptable.
Intraoperative injuries are obviated, and the postoperative outcomes are satisfactory.
Keywords: Biliovascular injury, STC.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1462

IntroductIon 1 Department of Surgery, University of Medical Sciences, Ondo, Nigeria
The popular procedure of cholecystectomy even performed 2 Faculty of Basic Medical Sciences, ABSU, Uturu, Nigeria
by laparoscopy is not devoid of the dangerous complications 3 World Laparoscopy Hospital, Gurugram, Haryana, India
of biliovascular injury. Despite innovation in the management
of biliary disease and the current approach using indocyanine Corresponding Author: George C Obonna, Department of Surgery,
University of Medical Sciences, Ondo, Nigeria, Phone: +2348038584310,
fluorescent imaging, the rates of intraoperative injury to structures e-mail: obonnadr@gmail.com
at the Calot’s triangle remain consistent. Figure 1 depicts the How to cite this article: Obonna GC, Obonna MC, Mishra RK.
procedure of laparoscopic cholecystectomy. Laparoscopic Subtotal Cholecystectomy: Our Experience. World J Lap
Conditions that predispose to serious complications at Surg 2021;14(2):95–97.
total cholecystectomy include empyema gallbladder (GB), Source of support: Nil

frozen Calot’s triangle, sessile GB, short/wide cystic duct, and
biliovascular anomalies. In these situations, a resort to open Conflict of interest: None
cholecystectomy may not improve the plane of dissection,
and there still exists the complication of biliovascular injuries.
Various authors have demonstrated biliovascular injuries MAterIAls And Methods
despite conversion to open cholecystectomy. 1–3 Subtotal This is a retrospective, descriptive cross-sectional study. Our health
cholecystectomy (STC) thus provides the window for removing management information system provided data from January
the GB without subsequent destruction of surrounding 2010 to January 2020. Cases of cholecystectomy were evaluated.
structures. It was in 1995 that madding provided the term of STC in our research was defined as leaving behind any portion of
STC in three cases and further description of the safety of the the GB other than the cystic duct. The follow-up data of the cases
procedure was done by Bornman and Terbanch, and Michalowski were noted, and all the patients had abdominal ultrasonography
et al. They described the steps of laparoscopic STC. 4,5 (USG) and liver function test (LFT). The primary aim of the study
The definition of STC, which is the inability of a surgeon to is to evaluate the turnout of STC, demographics, indications, and
safely divide the cystic duct which is not accepted, was provided surgical method.
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by Lidsky et al. and classification types of STC by Palanivelu The patients evaluated are those who do not have concurrent
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et al., Shin et al., and Strasberg et al. Figure 1 elucidates common bile duct stone confirmed by appropriate imaging.
the steps in laparoscopic STC. In our study, we evaluated our All patients who required an STC had their GB opened and
10 years of STC. remnant cleared of any stones during the surgery. The remnant
© Jaypee Brothers Medical Publishers. 2021 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License
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