Partial Cholecystectomy as a Safe and Viable Option in the Emergency Treatment of Complex Acute Cholecystitis: A Case Series and Review of the Literature

Abstract

Partial cholecystectomy (PC) is an alternative choice to standard cholecystectomy in situations with increased risk of Calot's components injury. We reported our experience with the patients treated with PC and reviewed the literature. Fifty-four patients with complex acute cholecystitis underwent PC, including conventional partial cholecystectomy (CPC; n = 48) and laparoscopic partial cholecystectomy (LPC; n = 6). The clinical diagnosis was verified by ultrasonography. In addition, we reviewed 1190 published cases (1972–2005) who underwent a “nonconventional” surgery for severe cholecystitis, including cholecystostomy, CPC, or LPC. Review of the literature, including our cases, showed a male:female ratio of 1.3:1. The major operative indication was severe acute cholecystitis. Procedures included cholecystostomy (65.8%) and PC (34.2%). In the follow-up (n = 1190), biliary leak (4.8%), retained stones (4.6%), recurrent symptoms (2.3%), wound infections (1.9%), persistent biliary fistula (0.9%), and prolonged biliary drainage (0.2%) were found, with an overall mortality rate of 9.4 per cent. In 133 patients, because of postoperative complications ( e.g., recurrent symptoms, remaining common bile duct stones, or persistence of bile fistula), reoperation was necessary, including 121 cases (90.1%) of cholecystectomy, whereas the other 11 patients underwent other procedures such as common bile duct exploration or closure of the fistula. The surgical trend for complex acute cholecystitis treatment has been changed from only cholecystostomy to a spectrum of cholecystostomy, CPC, and LPC with the progressive increase of PC. The proportion of the LPC compared with CPC has also increased during recent years. It seems that PC is a safe procedure for treating complicated acute cholecystitis. Whether the indication and need for alternative techniques to standard cholecystectomy is changing should be evaluated in future studies.

Laparoscopic or open cholecystectomy in cirrhosis: a systematic review of outcomes and meta-analysis of randomized trials

“…Given that conversion to OC is always an option, LC in cirrhosis should be at least as safe as ab initio open surgery provided that the surgeon who starts the procedure laparoscopically has a range of safe options available if problems arise intraoperatively. Commonly discussed options include laparoscopic subtotal 39,77–79 and partial 80 cholecystectomy, which have been used successfully to circumvent the hazards associated with dissection in the cirrhotic liver bed and around the porta hepatis. Other options include laparoscopic cholecystostomy 81 and percutaneous transhepatic cholecystostomy 82,83 .…”

A diagnosis reconsidered: the symptomatic gallbladder remnant

“…Only 5% of all elective laparoscopic cholecystectomies are converted to open, typically due to inflammation and adhesions impairing safe dissection . This inflammatory environment predisposes the patient to having, intentionally or unintentionally, a gallbladder remnant left behind . In our series, 11 patients had a laparoscopic converted to open cholecystectomy at the initial surgery.…”

Laparoscopic removal of a gallbladder remnant in a patient with severe biliary pancreatitis

“…In difficult cholecystectomies, surgeons may perform a subtotal cholecystectomy to reduce the risk of common bile duct (CBD) injury [ 1 ]. However, the gallbladder remnant can become diseased [ 2 ] and then requires completion cholecystectomy to limit subsequent morbidity.…”