Rajeev Narasimhappa1 , Anuroop Thota2
BACKGROUND Laparoscopic cholecystectomy (LC) has been recognized as the "gold standard" for the treatment of gallstone disease. The normal response to a difficulty in the safe dissection of Calot’s triangle is conversion to open surgery. Even after conversion, in majority of cases the only option is open subtotal cholecystectomy. With the advent in the expertise in laparoscopic surgery, laparoscopic subtotal cholecystectomy has been described as a safe and effective alternative to conversion to open surgery in difficult gall bladder, in selected cases. METHODS A retrospective study of all the cholecystectomies was conducted and number of difficult gall bladders encountered, and the conversion rate was assessed. Patients who underwent laparoscopic subtotal cholecystectomy were reviewed and a detailed analysis of the cases with regard to indications, role and effectiveness were studied. RESULTS A total of 354 patients underwent laparoscopic cholecystectomy in the time period. Of these, 40 were difficult cholecystectomies. Of the 40, 28 (70%) patients underwent conversion to open surgery, while 12 (30%) patients underwent laparoscopic subtotal cholecystectomy. The conversion rate is 7.9%. The rate of laparoscopic subtotal cholecystectomy is 3.38%. In the 28 patients converted to open surgery, 8 (28.57%) patients underwent open subtotal cholecystectomy. Among the 12 patients of LSC, 2 (20%) patients underwent LSC type 1 while 10 (80%) patients underwent LSC type 2. CONCLUSIONS Laparoscopic subtotal cholecystectomy can be used to avoid catastrophic bile duct and vascular injuries and hence reduce the rates of conversion. Hence, laparoscopic subtotal cholecystectomy (LSC) is a safe and feasible alternative.
