The outcome of laparoscopic subtotal cholecystectomy in difficult cases - A case series.

Introduction: Laparoscopic subtotal cholecystectomy (LSC) is a widely used technique for managing cholelithiasis with severe cholecystitis. The increasing popularity its utilization is due to the good safety profile and acceptable results. This case series evaluates the short- and long-term results of Indonesian patients who underwent LSC with an objective to determine whether the procedure can be a standard approach for difficult cholecystectomy in our institution.

Presentation Of Case: Thirty-four Indonesian patients (26 men, 8 women) with the mean age of 54.6 years (median 54 years, range 30-84 years) who underwent LSC were retrospectively analyzed. Nineteen patients are suffering from type II diabetes mellitus and fourteen patients with suspected choledocoholithiasis underwent ERCP prior to LSC. The major postoperative diagnosis was acute cholecystitis (16 patients), followed by gallbladder empyema (10 patients), chronic cholecystitis (5 patients), history of cholangitis (1 patient), Mirizzi's syndrome (1 patient) and stone retention post-ERCP (1 patient).

Discussion: The mean operating time was 158minutes (median 150minutes, range 60-240minutes), mean length of hospital stay of 4.6days (median 3days, range 2-33days) and drain usage for 3.6days (median 3.0days, range 1-19days). Postoperatively there was one case of bilioenteric fistula, one case of stone retention and two cases of prolonged upper gastrointestinal symptoms. There is no case of biliary leakage, peritonitis or wound infection.

Conclusion: The outcome of LSC in this case series is comparable with other publications showing a general favorability of LSC. Further studies are needed to elucidate the clinical benefits of several LSC technical points such as stump closure, posterior wall diathermy and drain usage. Based on this preliminary finding, LSC can be applied as a standard procedure for difficult cases in our institution.