Laparoscopic subtotal cholecystectomy for difficult gallbladder management: A single-center study.

Area of Science:

• Hepatobiliary Surgery
• Minimally Invasive Surgery
• Surgical Safety

Background:

• Achieving Critical View of Safety during laparoscopic cholecystectomy is challenging in severe inflammation or distorted anatomy.
• This difficulty significantly elevates the risk of catastrophic bile duct injury.
• Laparoscopic subtotal cholecystectomy serves as a crucial bailout procedure in such complex scenarios.

Purpose of the Study:

• To evaluate the safety and efficacy of modified laparoscopic subtotal cholecystectomy.
• To assess its role as a bailout operation when complete cholecystectomy is not feasible.
• To analyze operative variables, postoperative complications, and patient outcomes.

Main Methods:

• Retrospective study of 55 patients at BMHRC Bhopal (January 2024-January 2025).
• Inclusion criteria: chronic calculous cholecystitis, Mirizzi syndrome, gallbladder perforation, post-ERCP complications.
• Data collected on operative time, hospital stay, complications, and follow-up outcomes.

Main Results:

• Mean operative time: 78.5 ± 24.3 minutes.
• Mean hospital stay: 4.2 ± 2.8 days.
• Overall complication rate: 12%, with 2% major complications. Satisfactory outcomes observed at a mean follow-up of 8.7 ± 3.2 months.

Conclusions:

• Modified laparoscopic subtotal cholecystectomy is a safe and effective compromised surgical option.
• It prioritizes the avoidance of major bile duct injury in challenging gallbladder surgeries.
• The procedure demonstrates satisfactory operative variables, postoperative complications, and long-term outcomes.