Laparoscopic partial cholecystectomy: A safe and effective alternative surgical technique in "difficult cholecystectomies"

Abstract

Objective: Laparoscopic cholecystectomy has become the ''gold standard'' for benign gallbladder diseases due to its advantages. In the presence of inflammation or fibrosis, the risk of bleeding and bile duct injury is increased during dissection. Laparoscopic partial cholecystectomy (LPC) is a feasible and safe method to prevent bile duct injuries and decrease the conversion (to open cholecystectomy) rates in difficult cholecystectomies where anatomical structures could not be demonstrated clearly. Material and Methods:The feasibility, efficiency, and safety of LPC were investigated. The data of 80 patients with cholelithiasis who underwent LPC (n=40) and conversion cholecystectomy (CC) (n=40) were retrospectively examined. Demographic characteristics, ASA scores, operating time, drain usage, requirement for intensive care, postoperative length of hospital stay, surgical site infection, antibiotic requirement and complication rates were compared. Results:The median ASA value was 1 in the CC group and 2 in the LPC group. Mean operation time was 123 minutes in the CC group, and 87.50 minutes in the LPC group. Surgical drains were used in 16 CC patients and 4 LPC patients. There was no significant difference between groups in postoperative length of intensive care unit stay (p=0.241). When surgical site infections were compared, the difference was at the limit of statistical significance (p=0.055). Early complication rates were not different (p=0.608) but none of the patients in the LPC group suffered from late complications. Conclusion:LPC is an efficient and safe way to decrease the conversion rate. LPC seems to be an alternative procedure to CC with advantages of shorter operating time, lower rates of surgical site infection, shorter postoperative hospitalization and fewer complications in high-risk patients.

Efficacy of laparoscopic transversus abdominis plane block for elective laparoscopic cholecystectomy in elderly patients

“…It is well-known that less post-operative pain and rapid improvement in physical activity are the most important advantages of minimally invasive surgery [1]. Nevertheless, many patients suffer from significant pain after laparoscopic abdominal surgeries [2,3].…”

Damage-control laparoscopic partial cholecystectomy with an endoscopic linear stapler

“…Experienced surgeons may feel comfortable performing damage-control procedures laparoscopically (12).…”

Technical solutions for difficult laparoscopic cholecystectomies: Fundus-first technique and partial cholecystectomy

“…In a systematic review and meta-analysis, it was reported that partial cholecystectomy resulted in lower rates of common bile duct injury, but more frequent postoperative minor complications in difficult cholecystectomies. [6] Kulen et al [21] analyzed the data of 80 patients with cholelithiasis who underwent LPC (n=40) and conversion cholecystectomy (n=40). The authors reported that no patients in the LPC group suffered from late complications; however, the rate of late complications was 32.5% in the conversion cholecystectomy group.…”

“…Subhepatic collection, biliary fistula, and residual bile duct stones constituted the most frequent complications after LPC. [6,21] Palliative or minimally invasive techniques such as percutaneous drainage and ERCP are the most efficient treatments for such complications following LPC. [22] The incidence of postoperative ERCP after LPC was reported as 4.1%, and the most common indications for ERCP after LPC were retained stones (59%) and bile leakage (31.5%).…”