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. |
