Evaluation of surgical options in difficult gall bladder stone disease

Mirizzi syndrome (17%), shrunken gall bladder (32%) and frozen Calot's triangle (51%) were encountered in 41 cases of cholelithiasis. Difficult gall bladder stone disease was recognised at operation. Peroperative cholangiogram was done in 70% of the cases, CT scan in 27% cases and percutaneous transhepatic cholangiography (PTC) in 17% cases were done to rule out cancer. Operative procedures included removal of stones and cholecystostomy (5%), partial cholecystectomy (12%), subtotal cholecystectomy (52%), choledochoduodenostomy (22%), choledochoplasty (7%) and cholecystocholedochoduodenostomy (2%). Cholecystectomy (5%) was done in 2nd stage. There was no operative mortality. Postoperative complications included biliary leak (5%), septicaemia (2%) wound dehiscence (5%) and pulmonary infection (2%). It is concluded that subtotal cholecystectomy is an ideal, safe and simple procedure for difficult gall bladder stone disease.