Application of laparoscopic subtotal cholecystectomy in laparoscopic difficult cholecystectomy

Abstract

Objective To evaluate the clinical efficacy and safety of laparoscopic subtotal cholecystectomy (LSC) in laparoscopic difficult cholecystectomy. Methods Clinical data of 58 patients who were converted to other operation procedure during laparoscopic cholecystectomy (LC) in No.413 Hospital of People's Liberation Army between January 2011 and November 2016 were analyzed retrospectively. According to different converted operation, the patients were divided into LSC group and open cholecystectomy group (OC group). There were 31 cases in LSC group, 13 males and 18 females, with an average age of (57±18) years and 27 in OC group, 12 males and 15 females, with an average age of (54±16) years. The informed consents of all patients were obtained and the local ethical committee approval was received. Patients in LSC group were converted to laparoscopic antegrade or retrograde cholecystectomy, and the posterior gallbladder wall was retained. Patients in OC group underwent OC through the right subcostal incision. All the patients were followed up after operation. The operation time, intraoperative bleeding volume, postoperative pain score, drainage duration and length of hospital stay in both groups were compared by t test, and the incidence of postoperative complications was compared by Chi-square test. Results The operation time and intraoperative bleeding volume in LSC group were (68±10) min and (56±11) ml, significantly lower than (89±13) min and (81±28) ml in OC group (t= -7.2, -4.5; P 0.05). No postoperative death occurred in both groups. Conclusions For patients undergoing laparoscopic difficult cholecystectomy, compared with OC, LSC presents advantages of shorter operation time, less intraoperative bleeding volume and higher operation safety which are beneficial to the postoperative recovery of patients. Key words: Laparoscopes; Cholecystectomy; Blood loss, surgical; Postoperative complications