Laparoscopic Sub Total Cholecystectomy - An Alternative to Conversion to Open Cholecystectomy

Laparoscopic cholecystectomy is a common surgical procedure for gallstone disease. It is one of the common surgical procedures taught to surgical residents. The majority of the cases can be operated without problems. Patients with acute cholecystitis, chronic cholecystitis with frozen Calot’s triangle, and those with variations of biliary and vascular anatomy carry an increased risk of vasculo-biliary injuries. In these situations of difficult gallbladder surgery, the surgeon is often forced to convert to open cholecystectomy. Less than total cholecystectomy has been advocated for difficult operative conditions for more than 100 years. Conversion to Open Cholecystectomy does not guarantee adequate identification of anatomical structures and therefore does not eliminate the risk of vascular & bile duct injuries. Subtotal cholecystectomy allows for near total removal of the gallbladder and complete evacuation of the stones while avoiding dissection in the hazardous area. Laparoscopic subtotal cholecystectomy is an alternative approach to open cholecystectomy in a difficult gall bladder surgery. A retrospective study of subtotal cholecystectomy for a period of 2 years in our institution was done. 12 out of 167 laparoscopic cholecystectomies were difficult. 4 cases were converted to open surgery and 8 were managed by laparoscopic subtotal cholecystectomy.