The role of laparoscopic subtotal cholecystectomy in difficult laparoscopic cholecystectomy operations

Purpose: We assessed the applicability, indications, and benefits of laparoscopic subtotal cholecystectomy in treatment of complicated cholecystitis. Materials and Methods: We retrospectively compared the demographic and clinical characteristics, and surgical outcomes of 670 patients, who underwent standard laparoscopic cholecystectomy, and 13 patients who underwent laparoscopic subtotal cholecystectomy at the Istanbul Training and Research Hospital. Results: The 13 patients who underwent laparoscopic subtotal cholecystectomy consisted of 8 men and 5 women, of median age 59 years (range 41-76 years). Seven patients had fibrosis, four had acute cholecystitis, and two had type 1 Mirrizi's syndrome. Postoperative early complications were observed in one patient (7.7%). The median operating time was 103.85 minutes, and the median hospitalization time was 4 days. The LC group consisted of 167 men and 503 women, median age of 53 years (range 19-83 years). Of these patients, 604 had chronic cholecystitis with stones, 26 had acute cholecystitis with stones, 37 had chronic atrophic cholecystitis with stones, and 3 had gallbladder polyps. Following laparoscopy, 17 patients (2.5%) required open surgery. Postoperative complications were observed in 16 patients. The median operating time was 53 minutes and median hospitalization time was 1.35 days. Mortality was not observed in either group. Conclusion: laparoscopic subtotal cholecystectomy prevents bile duct injuries and serious hepatic duct bleeding in patients with benign complicated cholecystitis. In addition, laparoscopic subtotal cholecystectomy apparently reduces the conversion rate to open surgery.