The Efficacy of Subcostal-Approach Laparoscopic Cholecystectomy in Patients with Previous Midline Incisions: Comparative Analysis with Conventional Laparoscopic Cholecystectomy

Background: In patients with previous abdominal surgery, difficulties in laparoscopic cholecystectomy (LC) are associated with adhesions from the previous surgery. We reported the efficacy of a subcostal-approach LC (SALC) in patients with previous midline incisions. Subjects and Methods: Thirty-five patients with previous upper midline incision who underwent SALC from 2009 to 2013 at Korea University Medical Center (Seoul, Korea) were included. In SALC, a subcostal incision instead of an umbilical one was used to avoid adhesion in the midline scar. We compared the clinical outcomes of SALC with those of conventional LC in patients with previous midline incisions. Results: In the SALC group, there were 25 men and 10 women. The mean age was 64 years. Median operative time was 60 minutes, and the median length of postoperative hospital stay was 2 days. Most of the patients underwent three-port cholecystectomy. Three patients underwent conversion to open surgery. The SALC group had a significantly shorter postoperative hospital stay and shorter operation time compared with the conventional LC (with supraumbilical incision) group. Conclusions: SALC is a safe and effective procedure for patients who have had a previous midline incision that can help prevent unnecessary adhesiolysis.