Korean J Hepatobiliary Pancreat Surg.  2013 Nov;17(4):171-175. 10.14701/kjhbps.2013.17.4.171.

Experience with partial cholecystectomy in severe cholecystitis

• Lee W

• KMID: 2083343
• DOI: http://doi.org/10.14701/kjhbps.2013.17.4.171

Abstract

BACKGROUNDS/AIMS
Partial cholecystectomy (PC) is often an inevitable operative procedure when Calot triangle is severely inflamed and fibrosed with conglomerated structures. We reviewed our clinical outcomes of PC to compare its feasibility with conventional total cholecystectomy (TC), especially for its possible application to laparoscopic procedure.
METHODS
From Aug. 2000 to July 2008, 20 cases of PC by laparotomy were performed, including converted cases during laparoscopic cholecystectomy. Sixty-eight cases of TC by open method during the same period were compared in a mean follow-up period of 108 months.
RESULTS
Bile fistula was observed in 3 cases of PC; one case needed endoscopic biliary stent for management and a second case showed fistula that closed by supportive care in 2 months. The last patient died from peritonitis. No bile fistula was observed in PC. Morbidities were found in 9 cases of PC (45%) and in 11 cases of TC (16.2%). Bile fistula (n=3) and wound infection (n=3) were prominent in the PC group, and wound infection (n=7) in the TC group. Reoperations were necessary for 5 (25.0%) and 4 (5.9%) patients from PC and TC, respectively. Mortality occurred in 2 (2/10 10%) and 4 cases (4/68 5.9%) of PC and TC, respectively. Two mortalities in each group resulted from direct extension of cholecystitis.
CONCLUSIONS
Considering the higher risks of complications and mortality, PC should be avoided as long as possible, and patients should always be informed of its clinical outcomes postoperatively. Further elaboration of a safer operative plan should be sought.

Keyword

Cholecystitis; Partial cholecystectomy

MeSH Terms

Bile
Cholecystectomy*
Cholecystectomy, Laparoscopic
Cholecystitis*
Fistula
Follow-Up Studies
Humans
Laparotomy
Mortality
Peritonitis
Stents
Surgical Procedures, Operative
Wound Infection

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