Skip to main content
SpringerLink
Log in

Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review

  • Review
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

In the setting of difficult dissection of Calot’s triangle during laparoscopic cholecystectomy, conversion is commonly advocated. An alternative approach aimed at preventing bile duct injury is laparoscopic partial cholecystectomy (LPC). The safety and efficacy of this procedure are unclear.

Methods

A systematic review of the literature was performed independently by three researchers. The outcomes were conversion rate, hospital length of stay (LOS), bile duct injury, bile leak, symptomatic gallstones in the remnant gallbladder, need for reoperation, postoperative endoscopic retrograde cholangiopancreaticography (ERCP), percutaneous intervention, and mortality.

Results

The review included 15 publications, which reported on 625 patients. Four different operative techniques could be distinguished. Conversion to open (partial) cholecystectomy was performed in 10.4 % of the cases. The median LOS was 4.5 days (range, 0–48 days). The most common complication was postoperative bile leak, which occurred in 66 patients (10.6 %). One case of bile duct injury occurred. During the follow-up period, 2.2 % of the patients experienced recurrent symptoms of gallstones. Eight patients (2.7 %) underwent reoperation. Postoperative ERCP was performed for 26 (7.5 %) of 349 patients. A percutaneous intervention was performed for 5 (1.4 %) of 353 patients. Three deaths were described in the reviewed series (1 of pulmonary sepsis and 2 of myocardial infarctions). A rough comparison showed that fewer bile leaks, less need for ERCP, and less recurrent symptoms of gallstones seemed to occur when the cystic duct and gallbladder remnant were closed.

Conclusions

Literature concerning LPC is scarce. Four different LPC techniques can be distinguished. When a difficult gallbladder is encountered during LC, LPC seems to be a safe and feasible alternative to conversion. Closing of the cystic duct, gallbladder remnant, or both seems to be preferable.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Blum CA, Adams DB (2011) Who did the first laparoscopic cholecystectomy? J Minim Access Surg 7:165–168

    Article  PubMed  Google Scholar 

  2. Wiseman JT, Sharuk MN, Singla A, Cahan M, Litmin DE, Tsjeng JF, Shah SA (2010) Surgical management of acute cholecystitis at a tertiary care center in the modern era. Arch Surg 145:439–444

    Article  PubMed  Google Scholar 

  3. Buddingh KT, Hofker HS, ten Cate Hoedemaker HO, van Dam GM, Ploeg RJ, Nieuwenhuijs VB (2011) Safety measures during cholecystectomy: results of a nationwide survey. World J Surg 35:1235–1241

    Article  PubMed  CAS  Google Scholar 

  4. Wolf AS, Nijsse BA, Sokal SM, Chang Y, Berger DL (2009) Surgical outcomes of open cholecystectomy in the laparoscopic era. Am J Surg 197:781–784

    Article  PubMed  Google Scholar 

  5. Booij KA, de Reuver PR, van Delden OM, Gouma DJ (2009) Conversion has to be learned: bile duct injury following conversion to open cholecystectomy. Ned Tijdschr Geneeskd 153:A296

    PubMed  Google Scholar 

  6. Bornman PC, Terblanche J (1985) Subtotal cholecystectomy: for the difficult gallbladder in portal hypertension and cholecystitis. Surgery 98:1–6

    PubMed  CAS  Google Scholar 

  7. Bickel A, Shtamler B (1993) Laparoscopic subtotal cholecystectomy. J Laparoendosc Surg 3:365–367

    Article  PubMed  CAS  Google Scholar 

  8. Sharp CF, Garza ZR, Mangram AJ, Dunn EL (2009) Partial cholecystectomy in the setting of severe inflammation is an acceptable consideration with few long-term sequelae. Am Surg 75:249–252

    PubMed  Google Scholar 

  9. Palanivelu C, Rajan PS, Jani K, Shetty AR, Sendhilkumar K, Senthilnathan P, Parthasarthi R (2006) Laparoscopic cholecystectomy in cirrhotic patients: the role of subtotal cholecystectomy and its variants. J Am Coll Surg 203:145–151

    Article  PubMed  Google Scholar 

  10. Palanivelu C, Jani K, Maheskumar GS (2007) Single-center experience of laparoscopic cholecystectomy. J Laparoendosc Adv Surg Technol A 17:608–614

    Article  Google Scholar 

  11. Beldi G, Glättli A (2003) Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Endosc 17:1437–1439

    Article  PubMed  CAS  Google Scholar 

  12. Bonavina L (2007) Laparoscopic subtotal cholecystectomy. J Am Coll Surg. doi:10.1016/j.jamcollsurg.2006.10.033

  13. Chowbey PK, Sharma A, Khullar R, Mann V, Baijal M, Vashistha A (2000) laparoscopic subtotal cholecystectomy: a review of 56 procedures. J Laparoendosc Adv Surg Tech 10:31–34

    Article  CAS  Google Scholar 

  14. Horiuchi A, Watanabe Y, Doi T, Sato K, Yukumi S, Yoshida M, Yamamoto Y, Sugishita H, Kawachi K (2008) Delayed laparoscopic subtotal cholecystectomy in acute cholecystitis with severe fibrotic adhesions. Surg Endosc 22:2720–2723

    Article  PubMed  Google Scholar 

  15. Hubert C, Annet L, van Beers BE, Gigot JF (2010) The “inside approach of the gallbladder” is an alternative to the classic Calot’s triangle dissection for a safe operation in severe cholecystitis. Surg Endosc 24:2626–2632

    Article  PubMed  Google Scholar 

  16. Ji W, Li LT, Li JS (2006) Role of laparoscopic subtotal cholecystectomy in the treatment of complicated cholecystitis. Hepatobiliary Pancreat Dis Int 5:584–589

    PubMed  Google Scholar 

  17. Michalowski K, Bornman PC, Krige JEJ, Gallagher PJ, Terblanche J (1998) Laparoscopic subtotal cholecystectomy in patients with complicated acute cholecystitis or fibrosis. Br J Surg 85:904–906

    Article  PubMed  CAS  Google Scholar 

  18. Nakajima J, Sasaki A, Obuchi T, Baba S, Nitta H, Wakabayashi G (2009) Laparoscopic subtotal cholecystectomy for severe cholecystitis. Surg Today 39:870–875

    Article  PubMed  Google Scholar 

  19. Philips JAE, Lawes DA, Cook AJ, Arulampalam TH, Zaborsky A, Menzies D, Motson RW (2008) The use of laparoscopic subtotal cholecystectomy for complicated cholelithiasis. Surg Endosc 22:1697–1700

    Article  PubMed  CAS  Google Scholar 

  20. Ransom KJ (1998) Laparoscopic management of acute cholecystitis with subtotal cholecystectomy. Am Surg 64:955–957

    PubMed  CAS  Google Scholar 

  21. Singhal T, Balakrishnan S, Hussain A, Nicholls J, Grandy-Smith S, El-Hasani S (2009) Laparoscopic subtotal cholecystectomy: initial experience with laparoscopic management of difficult cholecystitis. Surgeon 7(5):263–268

    Article  PubMed  CAS  Google Scholar 

  22. Sinha I, Lawson Smith M, Safranek P, Dehn T, Booth M (2007) Laparoscopic subtotal cholecystectomy without cystic duct ligation. Br J Surg 94:1527–1529

    Article  PubMed  CAS  Google Scholar 

  23. Tian Y, Wu SD, Su Y, Kong J, Yu H, Fan Y (2009) Laparoscopic subtotal cholecystectomy as an alternative procedure designed to prevent bile duct injury: experience of a hospital in northern China. Surg Today 39:510–513

    Article  PubMed  Google Scholar 

  24. Macaron C, Qadeer MA, Vargo JJ (2011) Recurrent abdominal pain after laparoscopic cholecystectomy. Cleve Clin J Med 78:171–178

    Article  PubMed  Google Scholar 

Download references

Disclosures

Daniel Henneman, David W. da Costa, Bart C. Vrouenraets, Bart. A. van Wagensveld, and Sjoerd M. Lagarde have no conflicts of interest or financial ties to disclose.

Author information

Authors and Affiliations

  1. Department of Surgery, Sint Lucas Andreas Hospital, Jan Tooropstraat 164, 1061 AE, Amsterdam, The Netherlands

    Daniel Henneman, David W. da Costa, Bart C. Vrouenraets, Bart A. van Wagensveld & Sjoerd M. Lagarde

Authors
  1. Daniel Henneman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. David W. da Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Bart C. Vrouenraets
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bart A. van Wagensveld
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sjoerd M. Lagarde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Daniel Henneman.

Additional information

Daniel Henneman and David W. da Costa contributed equally to this manuscript.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Henneman, D., da Costa, D.W., Vrouenraets, B.C. et al. Laparoscopic partial cholecystectomy for the difficult gallbladder: a systematic review. Surg Endosc 27, 351–358 (2013). https://doi.org/10.1007/s00464-012-2458-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-012-2458-2

Keywords

Search

Navigation