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Laparoscopic Cholecystectomy
Table 1: Demographic profile of STC patients We conclude that STC is a useful alternative during the difficult
Age n = 60 GB surgery. Due consideration for STC must be given initially before
<40 8 rushing to the conclusion of conversion to an open procedure. STC
averts biliovascular injuries. The short-term and later outcomes of
40–49 10 STC are encouraging.
50–59 12
60–69 20
>70 10 references
Gender 1. Kacynski J, Hilton J. A gallbladder with the “hidden cystic duct”.
Male 40 A brief overview of various surgical techniques of the Calot’s triangle
dissection. Interv Med Appl Sci 2015;7(1):42–45. DOI: 10.1556/
Female 20 IMAS.7.2015.1.4.
2. Keus I, de Jong JA, Gooszen HG, et al. Laparoscopic versus open
cholecystectomy for patients with symptomatic cholecystolithiasis.
Table 2: Operative findings and tackling remnant of GB Cochrane Database Syst Rev 2006;(4):CD00231. DOI: 10.1002/14651858.
Indications for STC n = 60 CD006231.
Dense adhesions/frozen Calot’s triangle 34 3. Booij KA, de Reuver PR, ven Delden OM, et al. Conversion has
to be learned: bile duct injury following conversion to open
High insertion/short or wide cystic duct 5 cholecystectomy. Ned Tijdsehr Geneeskd 2009;153:A296.
Intrahepatic GB 5 4. Bornman PC, Terbanch J. Subtotal cholecystectomy. For the difficult
GB perforation/empyema gallbladder in portal hypertension and cholecystitis. Surgery
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Mirizzi 4 5. Michalowski K, Bornman PC, Krige JE, et al. Laparoscopic subtotal
Collaterals on GB wall 3 cholecystectomy in patients with complicated acute cholecystitis
Others 2 or fibrosis. Br J Surg 1998;85(7):904–906. DOI: 10.1046/j.1365-
2168.1998.00749.x.
Methods of closure of remnant 6. Lidsky ME, Speicher PJ, Ezekian B, et al. Subtotal cholecystectomy
Interrupted suture 43 for the hostile gallbladder failure to control the cystic duct
Purse-string suture 15 results in significant morbidity. HPB (Oxford) 2017;19(6):547–556.
Stapler 2 DOI: 10.1016/j.hpb.2017.02.441.
7. Palanivelu C, Rajan PS, Jani K, et al. Laparoscopic cholecystectomy
in cirrhotic patients: the role of subtotal cholecystectomy and
Conversion to an open procedure may not prevent biliovascular its variants. J Am Coll Surg 2006;203(2):145–151. DOI: 10.1016/
j.jamcollsurg.2006.04.019.
injury. 14 8. Shin M, Choi N, Yoo Y, et al. Clinical outcomes of subtotal
We had no case of biliary damage. Taking an early decision for cholecystectomy performed for difficult cholecystectomy. Ann Surg
an STC can obviate the danger of injury and very often prevent Treat Res 2016;91(5):226–232. DOI: 10.4174/astr.2016.91.5.226.
unnecessary conversion to open procedure. 9. Strasberg SM, Pucci MI, Brunt IM, et al. Subtotal cholecystectomy
Ten (16.7%) out of 60 patients developed a bile leakage and “Fenestrating” vs “reconstituting” subtypes and the prevention
were managed effectively by watchful waiting except one who had of bile due inner. Definition of the optimal procedure in difficult
laparotomy because he developed biliary peritonitis. We discovered operative conditions. J Am Coll Surg 2016;222(1):89–96. DOI: 10.1016/
a nidus of remnant GB for that patient, and peritoneal lavage and j.jamcollsurg.2015.09.019.
drainage was done. 10. Akcakaya A, Okan I, Bas G, et al. Does the difficult or laparoscopic
cholecystectomy differ between genders. Indian Surg 2015;77
None of our patients developed a wound infection. Meta- (Suppl. 2):452–456. DOI: 10.1007/s12262-013-0872-x.
analysis by Elshaer et al. showed that laparoscopic STC had lower 11. Chowbey PK, Sharma A, Khullar R, et al. Laparoscopic subtotal
rates of intra-abdominal collections, SSI, or reoperation rate. From cholecystectomy: a review of 56 procedures. J Laparoendose Adv
our experience, STC via the laparoscopic approach whenever we Surg Tech A 2000;10(1):31–34. DOI: 10.1089/lap.2000.10.31.
can in case of difficulty gives faster recovery, less chances of SSI, and 12. Elshaer M, Gravante G, Thomas K, et al. Subtotal cholecystectomy
15
acceptable long-term outcomes. Studies by Van Dijk et al. are in is difficult gallbladders”: systematic review and meta-analysis JAM
keeping with our findings. Surg 2015;150(2):159–168. DOI: 10.1001/jamasurg.2014.1219.
Removing the majority of the distensible portion of the GB 13. Henneman D, da Costa DW, Vroucnracts BC, et al. Laparoscopic
prevents any further stagnation/saturation of bile. It can be argued partial cholecystectomy for the difficult gallbladder. A systematic
review Surg Endosc 2013;27(2):351–358. DOI: 10.1007/s00464-012-
that a remnant GB might have been missed on ultrasonography 2458-2.
imaging. We, however, preferred not subjecting our patient to cross- 14. Kaushik R, Sharma R, Batra R, et al. Laparoscopic cholecystectomy:
sectional imaging in the absence of any symptoms or biochemical an Indian experience of 1233 cases. J Laparoendose Adv Surg Tech
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are asymptomatic, and it cannot be justified to subject them to any 15. Van Dijk A, Donkervoort SC, Lameris W, et al. Short and long-
kind of investigation or treatment. 16 term outcomes after a reconstituting and fenestrating subtotal
Regarding the risk of neoplasia, the mere presence of gallstones cholecystectomy. J Am Coll Surg 2017;225(3):371–379. DOI: 10.1016/
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is not a risk factor for malignancy. It may be argued that with the 16. Festi D, Reggiani MLB, Attili AF, et al. Natural history of gallstone
removal of the offending agent, further inflammation may subside. disease: expectant management or active treatment? Results
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