Comparison between Laparoscopic Subtotal Cholecystectomy and Open Conversion in Difficult Laparoscopic Cholecystectomy
Keywords:
Laparoscopic subtotal cholecystectomy, Laparoscopic cholecystectomyAbstract
Objective: Laparoscopic subtotal cholecystectomy (LSC), without approaching Calot’s triangle, is an acceptable option when standard laparoscopic cholecystectomy (LC) is not feasible. The aim of the present study was to verify the safety and efficacy of LSC as an alternative to open conversion (OC) in difficult LC, and to compare the clinical outcomes between LSC and OC in this setting.
Patients and Methods: From June 2011 to May 2021, there were 525 consecutive patients who underwent LC by the same surgeon. Three patients with suspected of gallbladder cancer were excluded. Open conversion was used in difficult cholecystectomy during the early period of LC, which will be called the “OC period”. Since June 2017, LSC was used as an alternative to OC, and the latter period was named the “LSC period”. The medical records of these 522 patients were analyzed retrospectively.
Results: There were 260 patients who underwent LC with 31 open conversion during the OC period and 262 patients underwent LC with 2 open conversion during LSC period. There were no differences in preoperative characteristics of patients between the two periods. The open conversion rate in the LSC period was significantly lower than that in OC period (0.8% versus 11.9%, respectively). Overall complication rates in LSC and OC periods were 1.6% and 5.4%, respectively. There was a significant difference in operative times (40.1 ± 16.0 versus 50.8 ± 22.7 minutes) and post-operative length of hospital stay (1.7 ± 1.2 versus 2.9 ± 2.5 days) between the LSC and OC periods, respectively. There was no significant difference in the 30-day readmission rates, and there was no 30-day mortality in the present study. All LSCs (n = 22) were completed without conversion to open surgery. Only one bile leakage (4.5%) and one case of retained common bile duct with retained remnant cystic duct stones was observed in these patients.
Conclusions: LSC as an alternative to OC in difficult LC has excellent clinical outcomes. LSC is a safe and effective alternative in the hands of experienced laparoscopic surgeons.
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