Partial Cholecystectomy in the Setting of Severe Inflammation is an Acceptable Consideration with Few Long-Term Sequelae

Abstract

Open cholecystectomy is infrequently performed. For the general surgeon, open cholecystectomy is typically performed when a great degree of inflammation precludes safe laparoscopic removal. The degree of inflammation can also lead to an unacceptable risk of common bile duct injury during the dissection of the triangle of Calot. In this situation, the extent of dissection and amount of resection is not well established. We undertook a retrospective review and follow-up telephone questionnaire of all partial cholecystectomies performed. Partial cholecystectomy was performed in 26 cases with open, laparoscopic converted to open, and laparoscopic techniques. Postoperative complications occurred in seven (27%) patients with three (12%) experiencing more than one complication. There was a bile leak in three (12%), subhepatic abscess in three (12%), wound infection in two (8%), and retained common duct stone in one (4%). There were no common bile duct injuries and no deaths. Telephone interviews were conducted with 19 (73%) patients. Average length of follow up was 314 days. At the time of last contact, no ongoing complaints attributable to biliary pain were present. Our data suggest that partial cholecystectomy in the setting of severe inflammation is a reasonable operation with few long-term sequelae, good clinical results, and satisfactory symptom relief.