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Related Experiment Videos

Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review.

Daniel Henneman1, David W da Costa, Bart C Vrouenraets

  • 1Department of Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE Amsterdam, The Netherlands. henneman.daniel@gmail.com

Surgical Endoscopy
|July 19, 2012
PubMed
Summary

Laparoscopic partial cholecystectomy (LPC) is a safe alternative to conversion during difficult laparoscopic cholecystectomy. Closing the cystic duct and gallbladder remnant in LPC may reduce complications like bile leaks and recurrent gallstones.

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Area of Science:

  • Gastroenterology
  • Surgical Innovation
  • Minimally Invasive Surgery

Background:

  • Difficult Calot's triangle dissection during laparoscopic cholecystectomy often leads to conversion.
  • Laparoscopic partial cholecystectomy (LPC) is an alternative to prevent bile duct injury.
  • The safety and efficacy of LPC remain unclear.

Purpose of the Study:

  • To systematically review the literature on laparoscopic partial cholecystectomy (LPC).
  • To evaluate the safety and efficacy of LPC as an alternative to conversion in laparoscopic cholecystectomy.
  • To compare outcomes of different LPC techniques.

Main Methods:

  • Systematic literature review performed by three independent researchers.
  • Inclusion of 15 publications reporting on 625 patients undergoing LPC.

Related Experiment Videos

  • Analysis of outcomes including conversion rate, length of stay, bile duct injury, bile leak, recurrent symptoms, reoperation, ERCP, percutaneous intervention, and mortality.

    • Main Results:

    • LPC conversion rate was 10.4%; median hospital stay was 4.5 days.
    • Postoperative bile leak (10.6%) was the most common complication; one bile duct injury occurred.
    • Fewer bile leaks, less need for ERCP, and fewer recurrent gallstone symptoms were observed when the cystic duct and gallbladder remnant were closed.

    Conclusions:

    • Literature on LPC is limited, with four distinct techniques identified.
    • LPC appears to be a safe and feasible alternative to conversion when encountering difficult gallbladders during laparoscopic cholecystectomy.
    • Closing the cystic duct, gallbladder remnant, or both is preferable in LPC.