Damage-control laparoscopic partial cholecystectomy with an endoscopic linear stapler

Özet

Objective: Several damage-control procedures have been described in the literature in case of severe Calot’s triangleinflammation and fibrosis. In this report, we describe patients who underwent laparoscopic partial cholecystectomyusing an endoscopic linear stapler.Materials and Methods: Five patients with acute cholecystitis underwent laparoscopic partial cholecystectomy in ourclinic between January - December 2011. All patients had severe fibrosis and inflammation of Calot’s triangle. Theanterior and posterior walls of the gallbladder were totally resected if possible. The gallbladder was transected at itsneck or Hartmann’s pouch, leaving a remnant gallbladder pouch behind.Results: Five patients had laparoscopic partial cholecystectomy with an endoscopic linear stapler. The main symptomof all patients on admission to the emergency room was abdominal pain. The mean time for the surgical procedurewas 140 minutes (range, 120-180 minutes). Inflammation and fibrosis of Calot’s triangle was detected in all patientsduring surgery and a phlegmonous gallbladder was detected in one patient. Surgical drains were used in all patientsand no biliary leakage was detected. Remnant common bile duct calculi were detected in one patient and this patientunderwent endoscopic retrograde cholangiopancreatography one month after surgery.Conclusions: When a reliable view of Calot’s triangle cannot be obtained due to severe inflammation and fibrosis during laparoscopy, laparoscopic partial cholecystectomy seems to be a safe and feasible alternative to open surgery withan acceptable morbidity rate.