Laparoscopic subtotal cholecystectomy by linear stapler: A simple and feasible technique for difficult cases with severe cholecystitis. A case series

• Published in: International journal of surgery open 2023-09, Vol.58, p.100671, Article 100671
• Main Authors: Noda, Keisuke, Kuroki, Tamotsu
• Format: Article
• Language: English
• Subjects: Laparoscopic linear stapler; Laparoscopic subtotal cholecystectomy; Reconstituting
• ISSN: 2405-8572; 2405-8572
• DOI: 10.1016/j.ijso.2023.100671

Laparoscopic subtotal cholecystectomy (LSC) is recognized as a safe, feasible alternative method for avoiding common bile duct injuries in 'difficult' gallbladders. We describe the details of an LSC technique that uses a linear stapler with the reconstituting method for severe cholecystitis. We retrospectively analyzed the cases of 19 Japanese patients diagnosed with acute cholecystitis who underwent LSC (Jan. 2017–Dec. 2020). In each patient, we first attempted to perform a standard laparoscopic cholecystectomy. Four trocars were inserted in all patients. When it was extremely difficult to expose and dissect the triangle of Calot or the neck of the gallbladder due to severe inflammation and fibrosis, an LSC was performed. The gallbladder was divided downward from the gallbladder fundus to the neck. We opened the gallbladder wall at the fundus and removed all gallstones with suction and saline flushing. The gallbladder was transected by a laparoscopic linear stapler. The median operation time was 166 min; intraoperative blood loss was 35 mL. One patient (5.3%) had minor bile leakage that promptly resolved after the transpapillary approach. The median postoperative hospital stay was 7 days. Using a linear stapler to divide the gallbladder neck is a simple, feasible strategy for LSCs in difficult gallbladders. •Laparoscopic cholecystectomy is a safe procedure that can avoid bile duct injury.•Failure to dissect the Calot's triangle increases the risk of bile duct injury.•Subtotal cholecystectomy does not require dissection of the Calot's triangle.•Postoperative bile leakage can be avoided by transection with a linear stapler.