Scientific paper
Subtotal cholecystectomy in acute cholecystitis

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Abstract

When feasible, total cholecystectomy is still the operation of choice in the surgical treatment of acute gallbladder disease and subtotal cholecystectomy should not be considered to supplant it. However, when complete removal cannot be safely accomplished, subtotal cholecystectomy recommends itself for consideration to obviate the use of cholecystostomy. Subtotal cholecystectomy incorporates the advantages of total cholecystectomy and has none of the drawbacks of cholecystostomy. A procedure such as cholecystostomy, which is followed by the need for further biliary tract surgery in such a large percentage of cases, leaves much to be desired. In all, excepting the extreme bad risk case in which a drainage operation only is permissible, subtotal cholecystectomy has proved, in my hands, a safe operation, yielding just as satisfactory permanent results as complete cholecystectomy.

Four cases are reported with no mortality and a morbidity comparable to that following total cholecystectomy in the treatment of chronically infected gallbladder with cholelithiasis.

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    Pre-operative risk factors for conversion include age, male gender, obesity, and concurrent cholecystitis.13 An alternative method, the subtotal cholecystectomy, was first described in the 1950s by Madding when faced with challenging dissection.14 Later, the laparoscopic subtotal cholecystectomy (LSC) was described by Bickel and Shtamler.15

  • Use of a piece of free omentum to prevent bile leakage after subtotal cholecystectomy

    2018, Surgery (United States)
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    One of these 6 patients developed postoperative bile leakage because the cystic duct had been closed with an unsecured metal clip, another leak was from the repaired hepatic duct, 2 were from the duct of Luschka, and 2 from unknown origin. Madding16 first reported SC in 1955 as an alternative for conventional total cholecystectomy as a rescue procedure in cases of a technically difficult total cholecystectomy that minimized the potential for injury to the bile duct and vascular structures when they were severely inflamed. SC was performed by piecemeal excision of the gallbladder, transecting the gallbladder neck or Hartmann's pouch, and leaving a rim of the posterior wall attached to the liver bed.

  • Subtotal cholecystectomy for the hostile gallbladder: failure to control the cystic duct results in significant morbidity

    2017, HPB
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    The technical challenges of operating on a severely diseased gallbladder are not unfamiliar amongst surgeons, where a hostile triangle of Calot fails to show its anatomy, and the inflammation prevents safe dissection and identification of the cystic duct in relationship to the portal structures. First reported in 1955 by Madding et al.,25 subtotal cholecystectomy is a technique to avoid common bile duct injury,3–18,20–22 and is described simply as the removal of only a portion of the gallbladder when inflammation precludes safe dissection and transection of the cystic duct.12,23 Unfortunately, the current body of literature reports at least three major surgical techniques for subtotal cholecystectomy (Table 5), making it challenging to interpret this data.

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