Laparoscopic subtotal cholecystectomy without cystic duct ligation

Background: Cholecystectomy is made hazardous by distortion of the anatomy of Calot's triangle by acute or chronic inflammation. Laparoscopic subtotal cholecystectomy (LSTC) without cystic duct ligation is an alternative to conversion to open surgery in difficult cases. Methods: This prospective study included all cholecystectomies performed in a district general hospital upper gastrointestinal unit between 2003 and 2005, after the introduction of LSTC. Results: Of 889 laparoscopic cholecystectomies, 28 LSTCs without cystic duct ligation were performed in 18 men and ten women of median age 68 years. Median operating time was 90 min and median duration of hospital stay was 3 days. Two temporary bile leaks resolved spontaneously on days 14 and 19. Three patients required endoscopic retrograde cholangiopancreatography, extraction of bile duct stones and stent insertion for persistent leaks. All five bile leaks were expected from peroperative findings. One patient had a myocardial infarction and one developed a subphrenic abscess. There were no deaths. Open conversion rates were reduced from 5.0 per cent in 1997-2002 to 0.3 per cent in 2005 (P < 0.001). Conclusion: LSTC without cystic duct ligation is an alternative to open conversion when dissection of Calot's triangle is hazardous. Bile leaks are predictable and readily managed.