Cystic duct closure during partial cholecystectomy: ten years' experience

When surgeons face difficulties in dissecting the Calot triangle during cholecystectomy due to severe inflammation or fibrosis, the proximal portion of the gallbladder is left in place to avoid injury to the bile duct; this procedure is called partial cholecystectomy (PC), and it is associated with a much higher complication rate after the operation.

We surveyed the clinical outcomes of 25 cases of PC by laparotomy during ten years from January 1998 to December 2007, for a total of 95 months of the mean follow-up period. Patients were separated in two groups for comparison: group I (n=15), in which cystic duct closure was tried from the intraluminal cystic ductal opening; and group II (n=10), in which cystic ductal circumferential ligation was possible.

Bile fistula occurred in 4 cases of group I, while no fistula occurred in group II. Postoperative peritonitis was observed in 4 cases from group I, with 3 of them caused by leakage of bile when the cystic duct could not be properly managed by stitches or staples. One of these peritonitis cases was fatal, but no case in group II showed peritonitis postoperatively. Wound infection, retained stone, and reoperations were also more frequent in group I, in 4, 2, and 5 cases. The mortality was 3 in group I and 1 in group II.

When inevitable partial cholecystectomy is carried out, more attention should be focused on secure ligation of the cystic duct, with the expectation of an improved outcome of the operation on a large scale. Otherwise, patients should be clearly informed about the high risks of postoperative complications.