Comparison of laparoscopic and open surgery in the treatment of Mirizzi syndrome / 中华肝胆外科杂志

Objective:To compare the laparoscopic and open surgery in the treatment of Mirizzi syndrome (MS).Methods:The clinical data of 125 patients with MS undergoing surgery in Tianjin Nankai Hospital from May 2013 to April 2020 were retrospectively analyzed, including 59 males and 66 females, aged (57.7±13.6) years old. Patients were divided into the laparoscopic group ( n=84) and open group ( n=41). General data, operation time, intraoperative blood loss, postoperative complications, postoperative and total hospital were compared between the groups. Patients were followed up and screened for biliary stone recurrence or biliary stenosis by phone or Wechat. Results:The postoperative hospital stay [8.00(5.25, 12.00) d vs. 13.00(10.00, 17.50) d, P<0.001] and total hospital stay [15.00 (10.25, 22.75) d vs. 22.00 (16.00, 27.50) d, P<0.001] were shorter in laparoscopic group. The conversion rate of laparoscopic group was 15.5% (13/84). No perioperative death occurred in either group. The incidence of postoperative complications were comparable between the groups [9.5%(8/84) vs. 7.3%(3/41), P>0.05]. In laparoscopic group, 64 patients were followed up [76.2% (64/84)]. During follow-up, there were two deaths, five cases of bile duct stones recurrence and one case of bile duct stenosis. In open group, 37 patients were followed up [90.2% (37/41)]. During follow-up, there were four deaths, four cases of bile duct stones recurrence. All deaths during follow-ups were non-MS-related. Conclusion:Compared to open surgery, laparoscopic surgery could shorten the total/postoperative hospital stay while does not increase the morbidity and mortality, which could be safe and feasible in the treatment of MS.

Clinical experience of laparoscopic subtotal cholecystectomy (468 cases) / 中国内镜杂志

Objective To investigate the indication and clinical experience of laparoscopic subtotal cholecystectomy. Methods We performed a retrospective analysis on the clinical data of 468 patients who underwent laparoscopic subtotal cholecystectomy from January 2012 to December 2015. Results There were no deaths. 7 cases that underwent laparoscopic cholecystectomy were converted to open surgery with laparoscopic subtotal cholecystectomy. 5 cases that were diagnosed with Mirizzi syndrome (3 cases with type I and 2 with type II) and 456 cases underwent laparoscopic subtotal cholecystectomy. No severe complication was detected after surgery. 16 cases with biliary leakage and 2 with duodenum leakage. The patients got recovered after a short time of drainage. 362 cases were followed up and the median follow-up time was (21.0 ± 4.9) months. 18 ones were with dyspepsia and 11 ones with upper or right upper discomfort. Conclusion Laparoscopic subtotal cholecystectomy was a safe choice and avoided injury of biliary duct for patients with severe adhesion of calot's triangle. The biliary leakage should be mainly observed during and after surgery.

Treatment principles and surgical skills in laparoscopic subtotal cholecystectomy for acute cholecystitis / 中华肝胆外科杂志

Objective To study the treatment principles and surgical skills in laparoscopic subtotal cholecystectomy (LSC) for acute cholecystitis.Methods We retrospectively analyzed the clinical data of patients who underwent LSC for acute cholecystitis from Jan.2006 to Dec.2015 at the Beijing Shijitan Hospital,Capital Medical University.We dissected any serious pericholecystic adhesions according to the principle that "It is better that the gallbladder rather than other tissue is injured",and the technique that "After the gallbladder anterior wall is excised,the gallbladder ampulla and duct are split along the longitudinal direction of the cholecystic duct,then the opened cholecystic duct is sutured inside the gallbladder".Results LSC was completed successfully in 96 patients.There were no conversion to open surgery,and no bile duct injury.The mean surgery time was (108.0 ± 37.0) min,the mean blood loss was (121.0 ± 62.0) ml,the mean peritoneal drainage was (105.0 ± 32.0) ml.The drainage tube was removed at a mean of (3.4 ±1.2) d after surgery.The mean hospitalization time after surgery was (6.1 ± 2.2) d.Surgical complications occurred in 2 patients with bleeding after surgery.One patient underwent laparoscopic exploration to stop bleeding.Another patient underwent conservative treatment and the bleeding stopped spontaneously.There were 3 patients who had mild bile leakage.All these patients recovered well after drainage.No patient developed bile duct stenosis or obstructive jaundice on follow-up.Conclusions LSC for acute cholecystitis was safe.Bile duct injuries could be avoided if we follow the principle of "It is better that the gallbladder rather than other tissue is injured" and the technique of "After the gallbladder anterior wall is excised,the gallbladder ampulla and duct are split along the longitudinal direction of the gallbladder,then the opened cholecystic duct is sutured inside the gallbladder".

Clinical experience of laparoscopic subtotal cholecystectomy (468 cases) / 中国内镜杂志

Objective To investigate the indication and clinical experience of laparoscopic subtotal cholecystectomy. Methods We performed a retrospective analysis on the clinical data of 468 patients who underwent laparoscopic subtotal cholecystectomy from January 2012 to December 2015. Results There were no deaths. 7 cases that underwent laparoscopic cholecystectomy were converted to open surgery with laparoscopic subtotal cholecystectomy. 5 cases that were diagnosed with Mirizzi syndrome (3 cases with type I and 2 with type II) and 456 cases underwent laparoscopic subtotal cholecystectomy. No severe complication was detected after surgery. 16 cases with biliary leakage and 2 with duodenum leakage. The patients got recovered after a short time of drainage. 362 cases were followed up and the median follow-up time was (21.0 ± 4.9) months. 18 ones were with dyspepsia and 11 ones with upper or right upper discomfort. Conclusion Laparoscopic subtotal cholecystectomy was a safe choice and avoided injury of biliary duct for patients with severe adhesion of calot's triangle. The biliary leakage should be mainly observed during and after surgery.

Treatment principles and surgical skills in laparoscopic subtotal cholecystectomy for acute cholecystitis / 中华肝胆外科杂志

Objective To study the treatment principles and surgical skills in laparoscopic subtotal cholecystectomy (LSC) for acute cholecystitis.Methods We retrospectively analyzed the clinical data of patients who underwent LSC for acute cholecystitis from Jan.2006 to Dec.2015 at the Beijing Shijitan Hospital,Capital Medical University.We dissected any serious pericholecystic adhesions according to the principle that "It is better that the gallbladder rather than other tissue is injured",and the technique that "After the gallbladder anterior wall is excised,the gallbladder ampulla and duct are split along the longitudinal direction of the cholecystic duct,then the opened cholecystic duct is sutured inside the gallbladder".Results LSC was completed successfully in 96 patients.There were no conversion to open surgery,and no bile duct injury.The mean surgery time was (108.0 ± 37.0) min,the mean blood loss was (121.0 ± 62.0) ml,the mean peritoneal drainage was (105.0 ± 32.0) ml.The drainage tube was removed at a mean of (3.4 ±1.2) d after surgery.The mean hospitalization time after surgery was (6.1 ± 2.2) d.Surgical complications occurred in 2 patients with bleeding after surgery.One patient underwent laparoscopic exploration to stop bleeding.Another patient underwent conservative treatment and the bleeding stopped spontaneously.There were 3 patients who had mild bile leakage.All these patients recovered well after drainage.No patient developed bile duct stenosis or obstructive jaundice on follow-up.Conclusions LSC for acute cholecystitis was safe.Bile duct injuries could be avoided if we follow the principle of "It is better that the gallbladder rather than other tissue is injured" and the technique of "After the gallbladder anterior wall is excised,the gallbladder ampulla and duct are split along the longitudinal direction of the gallbladder,then the opened cholecystic duct is sutured inside the gallbladder".

New variants of laparoscopic subtotal cholecystectomy in management of acute cholecystitis.

Background: Laparoscopic Subtotal Cholecystectomy has successfully brought down the conversion rate to a very low in difficult patients where the only option was conversion to open. Aims & Objective: To determine a new classification of Laparoscopic Subtotal cholecystectomy and their various types/variants like Type-I, Type-II and Type III and determine the use of port positions in LSC. Materials and Methods: The patients were recruited from specialized hospitalized which is recognized training centre for Laparoscopic Surgery. The 661 subjects were enrolled in the study. Both males and females were included in the study. All 14485 patients were subjected to Laparoscopic Cholecystectomy during the past 2 years and 5 months from February 2009 to June 2012. All surgical procedures were performed at a single tertiary level hospital. Among them, 661 patients (4.46%) with various types of cholecystitis were treated by Laparoscopic Subtotal Cholecystectomy and were included in the study. Results: The 48 patients belonging to Laparoscopic subtotal cholecystectomy-Type-I, only 4 ports were used in all 48 (100%) patients. No extra port was required. 591 patients belonging to laparoscopic subtotal cholecystectomy-type-II, 4 ports were used in 546 (92.39%) patients, 5 ports in 42 (7.10%) patients and 3 ports in 3 (0.50%) patients. Of 22 patients belonging to laparoscopic subtotal cholecystectomy-Type-III, only 4 ports were used in all 22 (100%) patients. No extra port was required. In all, in 616 (93.19%) procedures, 4 ports were used. In 42 (6.35%) procedures 5 ports were used (all Laparoscopic Subtotal cholecystectomy -Type-II), and in 3 (0.45%) procedures only 3 ports were used (all Laparoscopic Subtotal cholecystectomy -Type-II). Conclusion: In this study. Laparoscopic subtotal cholecystectomy has been further classified into Type-I, Type–II, Type–III. Laparoscopic subtotal cholecystectomy Type-I is used for difficult gall bladder bed. Laparoscopic subtotal cholecystectomy Type-II in difficult hilum, and laparoscopic subtotal cholecystectomy Type-III for difficult hilum with difficult gall bladder bed. In this study, laparoscopic subtotal cholecystectomy Type-III has been newly classified and this has helped us to bring down the conversion rate and other complications like bleeding and injury to biliary tree.

Efficacy and feasibility of laparoscopic subtotal cholecystectomy for acute cholecystitis

BACKGROUNDS/AIMS: For patients with acute cholecystitis, conversion from laparoscopic cholecystectomy to open surgery is not uncommon due to possibilities of serious hemorrhage at the liver bed and bile duct injury. Recent studies reported successful laparoscopic subtotal cholecystectomy for acute cholecystitis. The purpose of this study was to determine the efficacy and feasibility of such an operation based on the experience of surgeons at our facility. METHODS: In this study, we enrolled 144 patients who had received either laparoscopic subtotal cholecystectomy (LSC), laparoscopic cholecystectomy (LC), or open cholecystectomy (OC) for acute cholecystitis from January 2004 to December 2009 at the Department of Surgery of our hospital. Their symptoms, signs, operative findings, pathologic results and postoperative results were compared and analyzed. RESULTS: There were 26 patients in the LSC group 80 in the LC group and 38 in the OC group. There were no differences in mean age, sex, and symptoms of acute cholecystitis. The LSC group showed higher CRP levels (p<0.001) and a higher grade according to the Tokyo criteria (p=0.001). The mean operative time was 115.6 minutes and mean blood loss was 158.9 ml without intra-operative or postoperative transfusion. There weren't any bile duct injuries during the operation. No group suffered bile leakage. Drains were removed 3.3 days after the operation in the LC group, the shortest time compared to the other groups (p<0.001). LC and LSC groups demonstrated shorter postoperative hospital days and time to diet resumption than the OC group (p<0.001). CONCLUSIONS: LSC appears to be a safe and effective treatment in cases of severe acute cholecystitis that require consideration of conversion to open surgery.

Comparasion of fundus-first laparoscopic cholecystectomy and subtotal laparoscopic cholecystectomy in complicated cholecystolithiasis cases / 中国综合临床

Objective To compare the effects of fundus-first laparoscopic cholecystectomy and laparoscopic subtotal cholecystectomy in complicated cholecystolithiasis cases. Methods The effects of fundus-first laparoscopic cholecystectomy (n = 21) and laparoscopic subtotal cholecystectomy (a = 18) in the 39 cases of complicated chole-cystolithiasis from our hospital within 2 years were analyzed retrospectively. Results The operation time in subtotal laparoscopic cholecystectomy group was shorter than in fundus-first laparoscopic cholecystectomy group (88.89±18.11) min vs. (109.52±21.79) min, P < 0.05). Less blood lose (82.78±44.96) ml and fluid replacement (847.22±169.32)ml during the operation were observed in the former group than those in the later group (116.67±53.23) ml and (964.29±147.60) ml, respectively, P < 0.05). However, the patients' postoperative recovery time and the duration of postoperative hospital staying were similar in the two groups(5.56±1.20) days vs. (5.29±1.38) days, P > 0.05). Conclusions Proper use of subtotal laparoscopic cholecystectomy in complicated cholecystolithiasis cases can simplify the operation and obligate the operation time, which will increase the safety of the operation with the outcome similar to fundus-first laparoscopic cholecystectomy.

The application of laparoscopic subtotal cholecystectomy in complicated cholecystectomy / 中国微创外科杂志

Objective To study the possibility and safty of laparoscopic partial cholecystectomy in difficult cholecystectomy. Methods The operative procedures,efficaey and complications of 26 laparoscopic partial cholecystectomy between 1999 and 2001 were reviewed retrospectively.The operative indications were empyema cholecystitis, Mirris syndromeⅠtype,frozen Calot's triangle,shrunken gallbladder. Results operative time was (51?16 5) minutes;The time to recovey activity was (11?4 3) hours;food-intake began (22?8 5) hours after operation; The hospital stay was (4 5?1 5) days;bile leakage after operation was found in 2 cases and recovered after conservative management.Following-up period lasting 6 to 25 months showed no complecations occurred. Conclusions Laparoscopic subtotal cholecystectomy may simplify the operation and decrease the risk in difficult cholecystectomy,and can get the therapeutic result of cholecystomy combined with standard cholecystectomy.

Laparoscopic Subtotal Cholecystectomy:Report of 168 Cases / 中国微创外科杂志

Objective To investigate the feasibility and technique of laparoscopic subtotal cholecystectomy(LSC).Methods Totally 168 patients were converted to LSC because of failure in laparoscopic cholecystectomy(LC).During the LSC,the Calot's triangle was separated and then the Hartmann's pouch was incised to decreased the intracystic pressure for the removal of the stones.Results Among the cases,5 patients were converted to open surgery for subtotal resection of the gallbladder.LSC was completed after clipping the cystic duct and artery in 122 patients;in the other 41 cases,the gallbladder was cut at the Hartmann's pouch to clip the bile duct and artery or suture the neck of the gallbladder,and then LSC was performed.The median operation time was(65.5?15.2)min,and the intraoperative blood loss was(71.5?15.5)ml.The time to resume the diet was(20.4?6.3)h postoperation.After the operation,7 patients developed local complications(4.2%),and the mean postoperative hospital stay was(4.2?2.6)d.Of the patients,105 were followed up for(25.5?6.5)months,during this period,5 patients had dyspepsia,3 had right shoulder pain,and 9 had right hypochondrium pain.Conclusions LSC is feasible for patients with complicated cholecystitis.It is important to control the perioperative hemorrhage and bile leakage.

Laparoscopic Subtotal Cholecystectomy without Using Titanium Clips / 中国微创外科杂志

Objective To explore the feasibility of laparoscopic subtotal cholecystectomy without using titanium clips.Methods Laparoscopic subtotal cholecystectomy was performed without using titanium clips on 48 patients,who had serious adhesions at the Calot's triangle.The cystic duct was ligated by silk.Results The operations were completed uneventfully in all the cases without converting to open surgery.No massive hemorrhage or biliary leakage occurred during the operation.The patients were followed up for 3 months to 3 years(mean,18 months),during which no one developed abdominal pain,fever,or jaundice.Conclusions Laparoscopic subtotal cholecystectomy without using titanium clips is a safe and simple method for patients with serious adhesions at the Calot's triangle.The rate of postoperative complications is low.