Laparoscopic subtotal cholecystectomy: Our experience

Abstract

Background: The gold standard for gallbladder (GB) surgery worldwide is laparoscopic cholecystectomy. At the same time, complications that may arise from performing cholecystectomy can be horrifying. This is because in some cases, the complex anatomy can predispose the patient to the dangerous arteriovenous and biliary injuries. A subtotal cholecystectomy (STC) can, thus, obviate these complications. Aim: To examine the clinical spectrum of STC and the postoperative turnout of this procedure. Materials and methods: Our health management information system was used to collate our 10-year data (January 2010–January 2020) from the secondary and tertiary health facilities owned by Ondo State of Nigeria. Information on patients’ biodata, indication for surgery, surgical approach, laboratory evaluation, and radiological assessment was entered into a spreadsheet and analyzed using Statistical Package for the Social Sciences (SPSS) version 20 (OBM Incorporation). STC occurs when there is a remnant of the GB after GB surgery exclusive of the cystic duct. Results: A total of 60 (15%) out of 400 patients underwent laparoscopic STC. Closely compacted, complexly crowded constituents and adhesions at the Calot’s triangle were the main indications for STC. Ten patients (16.7%) had bile leakage after surgery. There were no biliovascular injuries, and 1-month mortality was zero. There was no case of surgical site infection. Over a consistent follow-up of 1 year, clinical examination, liver function test, and ultrasonography revealed no abnormality in any of the patients. Conclusion: STC is a rescue mission during difficult GB surgery. Early consideration for STC before conversion to open surgery is more acceptable. Intraoperative injuries are obviated, and the postoperative outcomes are satisfactory.