New variants of laparoscopic subtotal cholecystectomy in management of acute cholecystitis

Abstract

Background: Laparoscopic Subtotal Cholecystectomy has successfully brought down the conversion rate to a very low in difficult patients where the only option was conversion to open. Aims & Objective: To determine a new classification of Laparoscopic Subtotal cholecystectomy and their various types/variants like Type-I, Type-II and Type III and determine the use of port positions in LSC. Materials and Methods: The patients were recruited from specialized hospitalized which is recognized training centre for Laparoscopic Surgery. The 661 subjects were enrolled in the study. Both males and females were included in the study. All 14485 patients were subjected to Laparoscopic Cholecystectomy during the past 2 years and 5 months from February 2009 to June 2012. All surgical procedures were performed at a single tertiary level hospital. Among them, 661 patients (4.46%) with various types of cholecystitis were treated by Laparoscopic Subtotal Cholecystectomy and were included in the study. Results: The 48 patients belonging to Laparoscopic subtotal cholecystectomy-Type-I, only 4 ports were used in all 48 (100%) patients. No extra port was required. 591 patients belonging to laparoscopic subtotal cholecystectomy-type-II, 4 ports were used in 546 (92.39%) patients, 5 ports in 42 (7.10%) patients and 3 ports in 3 (0.50%) patients. Of 22 patients belonging to laparoscopic subtotal cholecystectomy-Type-III, only 4 ports were used in all 22 (100%) patients. No extra port was required. In all, in 616 (93.19%) procedures, 4 ports were used. In 42 (6.35%) procedures 5 ports were used (all Laparoscopic Subtotal cholecystectomy -Type-II), and in 3 (0.45%) procedures only 3 ports were used (all Laparoscopic Subtotal cholecystectomy -Type-II). Conclusion: In this study. Laparoscopic subtotal cholecystectomy has been further classified into Type-I, Type–II, Type–III. Laparoscopic subtotal cholecystectomy Type-I is used for difficult gall bladder bed. Laparoscopic subtotal cholecystectomy Type-II in difficult hilum, and laparoscopic subtotal cholecystectomy Type-III for difficult hilum with difficult gall bladder bed. In this study, laparoscopic subtotal cholecystectomy Type-III has been newly classified and this has helped us to bring down the conversion rate and other complications like bleeding and injury to biliary tree.