Laparoscopic Subtotal Cholecystectomy without cystic Duct Ligation

Background: Using laparoscopic approach, cholecystectomy is made hazardous by distortion of the anatomy of Calot's triangle due to acute or chronic inflammation and dense omental adhesions. Laparoscopic subtotal cholecystectomy (LSTC) without cystic duct ligation is an alternative to conversion to open surgery in difficult cases. Methods: This prospective study included 50 patients with different forms of clinical presentations subjected to LSTC at the surgical unit of the 2^nd floor in Baghdad Teaching Hospital and conducted during a period from Jan. 1^st, 2010 to Dec. 31^st, 2012. Results: Fifty cases of LSTC were performed, 32 of them were males and the remaining 18 patients were females. The age of study group ranged from (18 to 75) years with a median age of (46) year. The median operating time was about 90 min. and the mean duration of hospital stay was 7.3±2.2 days. There were 8 patients (16%) with postoperative bile leak, most of them recover spontaneously and only 2 patients (4%) underwent postoperative ERCP and stent insertion for persistent bile leak. 4 patients (8%) with postoperative wound infection and 2 (4%) with postoperative chest infection due to bile leak and longer operating time. One patient (2%) with subphrenic collection which mandates open drainage for cure. No mortality was recorded in our study. Conclusion:  LSTC is a possible alternative to open conversion in cases with Calot's triangle difficult anatomy and when dissection is hazardous. LSTC is associated with less injury to biliary passages in spite of longer operating time.