A DUSTED INDICATION FOR PROPHYLACTIC CHOLECYSTECTOMY AND YET FREQUENTLY CONSIDERED A SIGNIFICANT RISK FACTOR FOR DIFFICULT CHOLECYSTECTOMY: DM AND FATTY LIVER, SHOULD BE FOCUSED AGAIN AS AN INDICATION FOR PROPHYLACTIC CHOLECYSTECTOMY. A SHORT TERM FOLLOW UP STUDY OF LAPAROSCOPIC RECONSTITUTING SUBTOTAL CHOLECYSTECTOMY

Abstract

Background: Laparoscopic subtotal cholecystectomy has vital benefit in preventing severe bile duct injuries and outweighs the morbidity associated with subtotal gall bladder removal in certain circumstances. We Methods: evaluated the 81 patients who underwent Laparoscopic Reconstituting Subtotal cholecystectomy during July 2019 to Jan 2022. Preoperative parameters (Age, Gender, DM, Smoking, Alcohol, Fatty Liver) and postoperative parameters (Duration of surgery, Hospital Stay, Postoperative Bile leak, Postoperative ERCP stenting, retained stone, Mortality) were compared. Aim of the study was to evaluate outcome of the surgery and to identify the risk factors of bile leak. Results: Bile leak occurred in 5 patients (6.2%). All patient who had bile leak had fatty liver (p = 0.019, chi square test). Four out of five patients were diabetic (p = 0.079, ฀2 test). Four of five patients who had leak were above 50 yrs. of age group (P= 0.517, chi square test). Mean duration of surgery was higher for both Diabetic patients and Fatty liver patients, but statistically significant results were seen for Diabetics only (T test p=0.008). Laparoscopic recon Conclusion: stituting Subtotal Cholecystectomy is safe approach for the difficult cholecystectomy and with minimal/no risk of retained stones. Diabetes mellites and fatty liver are the risk factors to predict difficult cholecystectomy and we suggest the need for reconsideration of the recommendation for prophylactic cholecystectomy in diabetic patients with Asymptomatic cholelithiasis.