ThTP1.12 Stitch Closure of Gall Bladder Remnant during Laparoscopic Retrograde Subtotal Cholecystectomy for Difficult Gall Bladders

Abstract

Abstract Background and Aim Laparoscopic Retrograde Subtotal cholecystectomy (LRSC) recommended for difficult gall bladders (Grade 3&4, Nassar et al) reduces CBD injury (.08%), however, increases subhepatic collections (2.9%), reoperations (1.8%) and bile leaks (18%). Assess whether intracorporeal stitch closure of gall bladder remnant reduces complications and improves outcome. Patients and Method Prospective study of 1722 consecutive patients undergoing LC in a large DGH (2007-2022) with data of age, sex, BMI, ASA, grade of operation with postoperative stay and complications were collected and analysed. Group A: Conventional laparoscopic total cholecystectomy (LTC). Group B: LRSC includes a ‘fundus first approach’, piecemeal anterior & posterior wall transection with <1cm gall bladder remnant that is closed with a figure of 8 absorbable sutures. Results Group A: 1584(92%) with Male: Female 1:4 (363:1221), Age 51* (16-89) years, BMI 27* (17-65), ASA 2* (1-3), Grade 1* (1-4), Operating time 45* (15-200) minutes, PO stay 0* (0-15) day. 11(.7%) conversions, 3(.18%) CBD injury, 4 (.25%) bile leaks, 3(.18%) ERCPs, 13 (.82%) collections requiring 9 surgical wash outs and 4 radiological drainages. Group B: 138(8%) with Male: Female 1:1 (64:74), Age 61* (21-88) years, BMI 29 * (19-60), ASA 2* (1-3), Grade 4* (3-4), Operating time 100 *(40-240) minutes, PO stay 1 *(0-13) day. One (.72%) conversion, 6(4.3%) bile leaks, 3(2.17%) ERCPs and 3(2.17%) collections requiring 1 surgical wash out and 2 radiological drainages. Conclusion We recommend routine stitch closure of the gall bladder remnant during LRSC that significantly reduces post operative morbidity (bile leak and collection) for a better outcome. * Median