K. Leick1, D. Ring1, A. Bhama1, H. Chong1 1Universisty Of Iowa,Gastrointestinal-Minimally Invasive Surgery,Iowa City, IA, USA
Introduction: As laparoscopic cholecystectomy is now the gold standard for removal of the gallbladder, trainees and newly graduated surgeons are more experienced and comfortable with laparoscopic cholecystectomy (LC) as compared to open cholecystectomy (OC). Laparoscopic subtotal cholecystectomy (LSC) is a safe alternative to conversion to OC (COC) in difficult cholecystectomy cases. To our knowledge, no current literature exists comparing complications between these two procedures.
Methods: A single-institution retrospective chart review was performed on patients who underwent attempted LC over a 4-year period from July 2009 to July 2013. LC patients with common bile duct injury prior to conversion to open cholecystectomy were excluded from the study. Demographic characteristics and postoperative outcomes were analyzed. Statistics were performed using paired t-tests and χ2 in Microsoft Excel®, and a p value of <0.05 was considered significant.
Results: A total of 2646 patients underwent LC. Of these, 95% (n=2518) were completed laparoscopically, 2% (n=47) underwent COC and 3% (n=81) underwent LSC. Demographic characteristics were equivalent between COC and LSC group, except for age, as the COC group was significant older than the LSC group (58 ±17 vs. 49 ± 18, p=0.009). Intraoperative records demonstrated longer operative time with COC as compared to LSC (160 ± 90 minutes vs. 130 ± 37 minutes, p < 0.001). There was a significantly longer length of hospital stay in the COC group as compared to the LSC group (5.3 ± 2.3 days vs. 2.1 ± 2.5 days, p < 0.05). Overall, total complication rate was significantly higher with COC as compared to LSC (22.2% vs. 45.8%, p<0.02). These complications included: bile leak, retained common bile duct stone, acute kidney injury, urinary complications surgical site infection, small bowel obstruction or ileus, and postoperative arrhythmias. There was no significant difference in need for postoperative ERCP between the two groups.
Conclusion: LSC is associated with shorter length of hospital stay, shorter operative time, fewer complications and lower morbidity when compared to COC. Additionally, LSC is associated with decreased morbidity when compared to COC. In situations where standard laparoscopic cholecystectomy is not possible, performing LSC instead of COC should be considered as the next alternative.