Posted on 2023-09-20 02:06:17 by Sathish

     During laparoscopic cholecystectomy entire gall bladder will be removed. Cystic duct should also be removed and the stump of the cystic duct must be less than 5mm. But, sometime technically this may not be possible because of dense adhesions or anatomical malformations. At this stage it is very important to make sure that the CBD and other biliary apparatus are safe. So, in case of any technical difficulty, some part of gall bladder with cystic duct is left behind which can be tackled later. This is the concept of laparoscopic subtotal cholecystectomy. The main reasons for this procedure are presence of dense adhesions, frozen Calot’s triangle, suspected anatomical abnormality and poor general condition of patient where the prolonged anaesthesia will affect the patient recovery adversely.

    This procedure is done under general anaesthesia as routine laparoscopic cholecystectomy. Trocar placement and surgical techniques are same. During the course of dissection in case of any technical difficulty, the decision to proceed Subtotal Laparoscopic Cholecystectomy will be made. In this procedure gall bladder will be opened. All the contents will be evacuated. All the stones will be retrieved and kept in the endo-bag and removed at the end of the procedure. Every attempt is made to remove the maximum part of the gall bladder. The remanent gall bladder will be sutured with 2.0 vicryl sutures. After removing the specimen through endo-bag, wash will be given. Placement of drainage tube will be a routine procedure.

    The anticipated post operative complication is bile leak from the remanent gall bladder. In case of any prolonged post operative bile leak that can be tackled by ERCP and biliary stenting. The advantage of this procedure is that the injury to biliary apparatus is avoided. Also prolonged surgery can also be avoided in case of technical difficulty. The problems with this procedure is that possibility of developing bile leak during early post operative period which may necessitates ERCP and stenting and developments of stones again in the remanent gall bladder which requires revision gall bladder surgery. But the biggest advantage is that safer surgery without any damage to biliary tree which is very important.

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