Sub-Total Cholecystectomy - An Audit of Clinical Practice in a Tertiary Referral Hospital

Porter DJ*, Walter A, Lucocq J, Patil P and Alijani A

Department of General and Upper GI Surgery, Ninewells Hospital and Medical School, Scotland

^*Correspondance to: Darren J Porter 

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Abstract:

Introduction: Laparoscopic Cholecystectomy (LC) is the gold standard operative management
for symptomatic gallstone disease. When the ‘critical view of safety’ cannot be obtained during
dissection of Calot’s triangle, conversion to open cholecystectomy, fundus-first LC or Laparoscopic
Sub-Total Cholecystectomy (LSTC) may be considered.
This study evaluated the short and long-term results of patients who underwent a LSTC in a
university teaching hospital over a 5-year period to determine whether it is a safe procedure to
perform during difficult laparoscopic cholecystectomies.
Methods: Data was collected prospectively on all patients who underwent LSTC over a 5-year
period. A literature review was also undertaken using the Medline database of all studies published in
English from 1950 until 2018 using the terms ‘sub-total cholecystectomy,’ ‘partial cholecystectomy,’
‘difficult cholecystectomy’ and ‘fundus-first cholecystectomy’.
Results: Fifty-eight patients underwent LSTC between 2013 and 2018. There was no recorded
mortality in any of the 58 patients over the 2-year follow-up period. In addition there were no bile
duct injuries or significant bleeding in any of the patients in this study.
In 92% of patients LSTC was the definitive surgical management of their condition.
Conclusion: The authors believe that LSTC should be considered as part of the treatment algorithm
when faced with complicated gallbladder disease. The authors advise that conversion to open
cholecystectomy and fundus-first cholecystectomy should be avoided in the setting of severe acute
cholecystitis.

Keywords:

Total cholecystectomy; Sub-total cholecystectomy; Fundus-first cholecystectomy; Hostile gallbladder

Cite the Article:

Porter DJ, Walter A, Lucocq J, Patil P, Alijani A. Sub-Total Cholecystectomy - An Audit of Clinical Practice in a Tertiary Referral Hospital. World J Surg Surgical Res. 2020; 3: 1190..