MODIFIED CHOLECYSTECTIOMY (SUBTOTAL) FOR CHRONIC CALCULAR CHOLECYSTITIS IN CIRRHOTIC PATIENTS
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Twenty patients suffering from chronic calcular cholecystitis, liver cirrhosis and portal hypertension underwent subtotal cholecystectomy. Selection of the patients was based on the severity of symptomatic cholelithiasis and good liver functions (Child's A & B). The operation entails opening of the gallbladder, securing the cystic duct at its origin from within the gallbladder with a purse string suture and excision of the anterior wall leaving the posterior wall of the gallbladder atteched to the liver to prevent massive blood loss from the gallbladder bed. This obviates the need for dangerous dissection in Calot's triangle. liemostasis from the remaining gallbladder edge was achieved by continuous underrunning suture. Operative mortality reported in one patient (5%) in whom accidental intraoperative bleeding encountered with postoperative liver cell failure and fulminant infection occurred. Wound infections occurred in 2 patients (10%). No patient developed, intraperitoneal sepsis or mucous discharge. Subtotal cholecystectomy is a definitive operation for chronic calcular cholecystitis in cirrhotic patients who need surgery. It is safe and rather easy procedure being not followed by increasing incidence of morbidity or mortality and at the same time it avoids the occurrence of massive bleeding encountered with formal cholecystectomy in cirrhotics.